New Service - Residential
This form is to establish service at a Residential property with an Existing Meter
Name
*
First Name
Last Name
Would you like to add anyone else to the account?
First and Last Name of the person you are adding
Email
*
example@example.com
Driver's License or State Issued ID Number
*
Please include the issuing state
A copy of your Driver's License or State Issued ID is required
*
Browse Files
Drag and drop files here
Choose a file
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of
Social Security Number
*
SSN
Primary Phone Number
*
Please enter a valid phone number.
Primary Phone Type
*
Please Select
Home
Cell
Work
Secondary Phone Number
Please enter a valid phone number.
Secondary Phone Type
Please Select
Home
Cell
Work
Employer Name
*
Employer Name
Employer Phone Number
*
Please enter a valid phone number.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Service Address
*
Service Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you Rent or Own this property?
*
Please Select
Rent
Own
When would you like to Establish Service?
*
-
Month
-
Day
Year
Date
Additional Comments or Information
Additional Comments or Information
Signature
*
By signing you agree to the Terms & Conditions as well as the Rules & Regulations set forth by the Arizona Corporation Commission
Please verify that you are human
*
Number of Occupants
*
Type option 1
Type option 2
Type option 3
Type option 4
Other
Submit
Should be Empty: