Non-Residential Service Application

Non-Residential Service Application
Applicant Information
Business Name
Federal Tax ID #
Business Phone Number
Phone Number
Type of Business
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sales Tax Exempt (must provide certificate)
Upload Sales Tax Certificate

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Emergency Contact Info
Emergency Contact Name
Emergency Contact Phone Number

Owner Information
Owner Name

First NameMiddle NameLast Name
SSN
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Owner Phone Number
Owner Email
jdoe@ecarthage.com
Upload a scan or photo of applicant ID

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Co-Owner Information
Co-Owner Name

First NameMiddle NameLast Name
SSN
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Co-Owner Phone Number
Co-Owner Email
jdoe@ecarthage.com
Upload a scan or photo of applicant ID

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Authorized Representatives

Authorized Company Representatives can make changes to account and receive account information.

Property Information
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If property is used as a residence, who will be living at the property?
If property is used for a business, what type of business?
Ownership
Landlord's name
Lease agreement or proof of ownership

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Contract Signatures
Any and all services provided shall be subject to the regulations, policies, and rates of CWEP. I understand that I am responsible for the utility billing at the above property from the date of requested connect (or transfer) until I personally order the service off. This information serves as a contract for utility service with Carthage Water & Electric Plant.
Applicant
Co-Applicant
Should be Empty:

Applicant Information