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If your meter is currently OFF; please call our office at (920) 683-4600

Account Information: Service Address

* Required

Service Start Date (Monday – Friday)(*)
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Note: Two business days is required

Customer's Last Name(*)
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First Name(*)
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Middle Initial(*)
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Address for Service to start(*)
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Apt Number/House Designation (i.e. upper/lower)
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City/State and Zip(*)
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Home Phone Number(*)
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Alternate Phone Number
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Previous Address(*)
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Previous City(*)
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Previous State(*)
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Previous Zip Code(*)
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Will you be purchasing this property?
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Will you be renting this property?
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Date of Birth
Month
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Day
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Year
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Social Security Number(*)
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Place of Employment/Income Source(*)
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Would you like your bills mailed to a different address than the service address noted above?
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If yes, please enter mailing address
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Would you like anyone else to appear on the account billing? (i.e. Spouse/Roommate)
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If yes, please have the party complete their own application.

Are you submitting this form on behalf of someone else?
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Landlord’s Name and Phone number
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Power of Attorney/Personal Rep/Guardian?
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Name
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Address
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Phone number
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Applicant Name(*)
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Email Address(*)
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