New Service Application

Please complete this form to apply for new Residential, Commercial, or Prepaid service.

Today's Date:(Required)

Date service is desired:(Required)

Type of Request:(Required)

SSN:(Required)

Birthdate:(Required)

Employer:

Service Type:(Required)

Meter Number:(Required)

Comments:

Phone Number:(Required)

Cell Phone:

Business Phone:

Co Applicant SSN:

Co Applicant Birth Date:

Co Applicant Employer:

Co Applicant Signature:

I understand that typing my name in the field provided is my electronic signature.

If you do not own this service location, please list landlord name.

Account Number:

Fee & Deposit Information All applicants are required to pay a $5.00 membership fee. Residential and Commercial applicants may be required to pay a security deposit, based on the results of a credit check, before service is connected. Prepaid applicants are not required to pay a security deposit but will be required to establish a credit balance to be applied to future energy use. When your account is created, you will receive an email with the total amount due on your new account, including the deposit amount, if applicable. For more information on prepaid service visit this page.

Upload ID(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB.

Please attach a valid driver's license or a state issued ID.

Applicant Signature(Required)