Service/Transfer Application for Electric & Water Service

If you are renting please submit copy of the lease agreement to Town Hall.

If you are buying/owner, please submit a copy of the closing document to Town Hall.

A hard copy of the form is attached below as a PDF. Please return it to Town Hall if you fill out a hard copy instead.

Applicant:

Email Address:

Service Address:

Drivers License #:

Date of Birth:

SSN:

Mailing Address (P O Box or if different from service address):

Date to be connected:

Phone #:

Name of Landlord (if renting):

Landlord Phone #:

Buying/Own:

Yes

Renting:

Yes

What address are you moving from?:

Place of Employment:

Do you want service cut off at old address Yes or No:

If so, what date and forwarding address: