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Service

ERROR

Service Account Number

Date

12/11/17

Reason

Schedule Date

First Name

Last Name

Mobile Number

Alternate Number

Schedule Time

Middle Name

Pets

Locked Gates

Start Service | Home

Enter your information

Please enter contact information for the person responsible for the account

First Name

Email ID

Date of Birth

Alternate Number

Mobile Number

Will any other adults be living at the new service address?

Last Name

SSN

Mobile Number

Mobile Number

First Name

Relationship

Date of Birth

Last Name

SSN

Current Address

Please enter your current address

Street Number

Type

City

Zip Code

Is this address served by [UTILITYNAME]?*

Street Name

Apt/Unit Number

State

Where are you moving to?

Please enter the address where you'd like to start service.

Requested Start Date

(Requests will be processed the next business day)

Street Name

Apt/Unit Number

State

Do you own or rent this home?

Own Rent

Street Number

Type

City

Zip Code

Billing Address

Same as New Address

Please enter the address where you'd like your bill sent.

Street Address P.O. Box

Street Number

Type

P.O. Box

State

Street Name

Apt/Unit Number

City

Zip Code

Security Deposit and Setup Fee

Utility Company will assess a non-refundable $15 connect fee for all newly activated electric accounts. Additionally based on your credit you are required to provide a security deposit of $250 for this new account. Please select payment options below to pay the connect fee and security deposit

Card Number

Month

Security code

Year

Please Verify

Where are you moving to?

Apt/Unit Number

State

When are you moving in?

(Request will be processed the next business day)

Street Name

City

Zip Code

Contact Information

Mobile Number

Email ID

Alternate Number

Mailing Address
Same as moving address

Apt/Unit Number

State

Street Name

City

Zip Code

When?

When are you moving out?

(Requests will be processed the next business day)

Contact Information

Mobile Number

Email ID

Alternate Number

Mailing Address

Street Number

Apt/Unit Number

State

Street Name

City

Zip Code

When?

When are you moving out?

(Requests will be processed the next business day)

Where are you moving to?

Street Number

Street Name

City

Zip Code

Apt/Unit Number

State

When are you moving in?

(The Request will be processed the next business day)
Contact Information

Mobile Number

Email ID

Alternate Number

Mailing Address
Same as moving address

Street Number

Street Name

City

Apt/Unit Number

State

Zip Code


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Additional Comments

Use this form to contact Utility Company to make a service request, such as move in, move out, transfer service, etc

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