New Residential Service

Customer Information

*Date of new service

*Name(s) on account

New Address

*Street Address
Apt.
*City
*State
*Zip

*Primary phone
Secondary phone

Email

*Rent or Own: Rent Own
New landlord name

New landlord phone number

Previous Address

*Street Address
Apt.
*City
*State
*Zip

*Primary phone
Secondary phone

*Rent or Own: Rent Own
Previous landlord name

Previous landlord phone number

Employer

Employer name

Employer phone number

Spouse or Roommate Information

Name

Employer name

Employer phone number

Any other specific instructions:

*Required fields: this information is required to open a new account for electric service. The utility may need to contact you to verify any or all of the information.