Application for Service

Application for Service
Select Your System:*
Service Address:*
(Street Number & Name Only)
Unit #:
Requested Service Start Date:*

MonthDayYear
Mailing Address:*

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Individual or Business:*
Business Name:*
Legal Name:*

First NameLast Name
Form of Identification:*
Driver's License #:*
Driver's License State:*
Passport #:*
Passport Country/Province:*
Tax ID #:*
Phone #:*
E-mail Address:*
E-billing: JACABB Utilities no longer offers printed bills. Please make sure the email provided is active and monitored so that bills are deliverable.
Spouse/Roommate Information:
Own or Rent:*
Landlord's Name:
Landlord's Phone:
Please verify that you are human:*
Once you have completed all of the required fields above, you can submit your application by clicking 'Submit' below. A $25.00 application fee will be included with your first bill.

Please allow 2 business days for processing.
Should be Empty: