Utility Service Application

UTILITY SERVICE APPLICATION

Parties

Recitals

WHEREAS, Applicant has applied to receive utility services (electric, gas, water, or combined) from Utility Provider identified above; and

WHEREAS, Utility Provider is willing to provide such services to Applicant subject to the terms, conditions, fees, and deposit requirements set forth in this Utility Service Application and the Service Terms and Conditions incorporated herein; and

WHEREAS, the parties agree that acceptance of service by Utility Provider shall form a binding agreement upon the terms set forth below.

Applicant Contact & Service Location

Account Classification & Identification

Select account type (check applicable):

Residential Commercial Industrial Other

Scope of Service

Describe the requested utility services, meter locations, load requirements, and any special installation instructions. Include any access, easement, or construction notes relevant to providing service.

Requested Service Start Date:

Payment Terms & Fees

By signing below, Applicant agrees to pay charges for service in accordance with Utility Provider's rates and the following terms:

Deposit required prior to connection (if applicable): $. The deposit is held as security and may be applied to unpaid charges in accordance with policy.

Billing cycle: . Payment due within days from invoice date.

Late payment penalty: % per month on outstanding balance. Returned check fee: $. Reconnection fee: $.

Term and Termination

Term commences on Service Start Date and continues until terminated by either party consistent with this section.

Service Start Date: . If an end date is agreed, End Date: .

Either party may terminate service for cause upon written notice. If termination without cause is permitted, a written notice of days is required. Applicant remains responsible for charges through the effective termination date, including any applicable disconnect or restoration fees.

Confidentiality

Each party shall maintain as confidential all non-public business or personal information disclosed in connection with this Application and the provision of service, except where disclosure is required by law or as necessary to collect charges, perform service, or where information is or becomes publicly available through no breach of this provision. Confidential information may be disclosed to affiliates, agents, or contractors on a need-to-know basis provided that such parties agree to confidentiality obligations at least as protective as those contained herein.

Governing Law & Entire Agreement

This Application, together with any Service Terms and Conditions incorporated by reference, constitutes the entire agreement between Applicant and Utility Provider with respect to the subject matter hereof and supersedes all prior representations, negotiations, and agreements. No amendment shall be binding unless in writing and signed by both parties.

Authorizations & Certifications

Applicant certifies that all information provided in this Application is true and correct. Applicant authorizes Utility Provider to obtain consumer credit reports, verify references, and perform any necessary checks to establish service. Applicant agrees to comply with all applicable rules, tariffs, and codes governing service.

Applicant acknowledges responsibility for safe access to the service location for meter reading, maintenance, and disconnection if necessary.

Applicant authorizes direct contact for billing and service notices at the email and phone number provided above:

I have read, understand, and agree to the terms, fees, and conditions set forth in this Utility Service Application and the attached Service Terms and Conditions (if any).

Sign Now