Application For Utility Service Please enable JavaScript in your browser to complete this form.Service Request (check one) *StartStopTransferApplicant *FirstLastMI or Business Name C/O or Person of ContactSocial Security Number/ Tax ID Do you give permission for us to run a soft credit check? *YesNoPrevious Address (If transferring service to new location or canceling service)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate to DisconnectService Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStart Date *Mailing Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTelephone 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 agreeAccounts 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 agreeI 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 agreeFOR OFFICE USE ONLY Account#WO#Closing Date/Beginning Lease Date(Documentation Required)DepositService FeesTotal Amount Location Services Electric, Gas, Water, Sewer Water & SewerWater Only Electric Only Gas Only Submit