Application for Residential Electric Service

(Please note that all applications for service are subject to credit check)

For locations that have had prior electric service, we offer same day service at no additional charge for applications received before 3 p.m. For a $25 fee, applications received between 3 p.m. and 5 p.m. can also be connected the same day.

Otherwise, applications received after 3 p.m. will be connected the next business day.

Information on this application will be used for the purpose of a credit check. Depending upon the results of your credit check, you may be required to pay a deposit in full prior to electric service being connected.

NOTE: All fields in RED are required. After hitting submit, you should get a confirmation page and a confirmation email. If you do not, then the application has not been submitted.

Name	Last First Middle
Company Name if applicable
Service Address
Mailing Address if different from above
City
State	AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY   Zip
Driver's License #	State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Social Security #
Email
Confirm Email
Home Phone #
Business Phone #
Current Phone # include Area Code
Employer's Name
Employment Address
Spouse's Name
Spouse's SSN
Next of Kin
Relationship
Next of Kin Address
Next of Kin Phone #
Landlord
Landlord Phone
Date Service is Desired