Application For Utility Service

 

Service Request (check one) *StartStopTransfer

Applicant *

First

Last

MI or Business Name

C/O or Person of Contact

Social Security Number/ Tax ID

Do you give permission for us to run a soft credit check? *YesNo

Previous Address (If transferring service to new location or canceling service)

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Date to Disconnect

Service Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Start Date *

Mailing Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Telephone Number *

Alternate Phone Number

Email *

Please Check Your Information

In consideration for receiving electric, gas, water, and/or sewer service from Dalton Utilities, at the above location, I hereby acknowledge responsibility for payment of service billings. *

• I agree

Accounts are billed on a monthly basis and payment by the indicated due date is required to prevent interruption of service. I am responsible for electric, gas, water, and/or sewer service until the account is closed. *

• I agree

I have read and agree to the terms and conditions. I further understand that applications will not be processed without appropriate identification, documentation and payment. *

• I agree

FOR OFFICE USE ONLY

Account#

WO#

Closing Date/Beginning Lease Date

(Documentation Required)

Deposit

Service Fees

Total Amount

Location Services

• Electric, Gas, Water, Sewer
• Water & Sewer
• Water Only
• Electric Only
• Gas Only

Submit