2. Utility Account Number*
   Please enter your 10 digit utility account number
3. Last Name*
   Last name as it appears on your utility account.
5. Service Location Address*
7. E-mail address to receive your billing statement*
9. Contact Phone*
11. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
13. Electronic Signature*
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

* indicates a required field