Owner Occupant Application

Service Information

Service Address

City , State, Zip

Effective Date

Owner Information

Customer Name

Customer Social Security Number

Customer Date of Birth

Customer Phone Number

Customer E-mail Address

Co-Applicant

Co-Applicant Customer Name

Co-Applicant Social Security Number

Co-Applicant Date of Birth

Co-Applicant Phone Number

Co-Applicant E-mail Address

Mailing Information (If Different From Service Address)

Mailing Street Address or PO Box

Mailing Address City, State & Zip Code

Previous Service Address (If Had District Service Before)

Previous Service Address

Previous Service Address City, State, Zip

Preauthorized Payments

Would like to signup for Preauthorized Payments ?

YES (If yes please provide routing number and account number)

Routing Number

Account Number

Applicant Drivers License / ID

Co-Applicant Drivers License / ID

Grant Deed

Customer Signature

Disclaimer IT IS UNDERSTOOD THAT IF YOU DID NOT UPLOAD THE REQUIRED DOCUMENTS THIS APPLICATION WILL BE REJECTED UNTIL THE REQUIRED DOCUMENTS ARE INCLUDED. NO EXCEPTION. IF YOU DO NOT HAVE THE DOCUMENTS ATTACHED, DO NOT SUBMIT THE APPLICATION.