Start Service - Clark Public Utilities

Email

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General Primary Account Holder Information

I am requesting utility service at the indicated location. By completing this form I agree to be financially responsible for the cost of all utility services provided by Clark Public Utilities at this location until the account is closed.

I am requesting utility service on behalf of my tenant. By completing this form, I certify that I am authorized to initiate this account, have verified the identity of my tenant, and that I currently have a rental agreement in place. I understand that if I sign up for utility service on behalf of another person, without authorization or verifying their identity, I may be personally responsible for this account.

Phone Number:*

Email Address:*

Social Security Number:*

Why do you need my SSN? Social Security numbers are required to start electric service and this website is encrypted and secure. If you do not have a social security number, please contact Customer Service at 360-992-3000 before submitting your form and a representative will help you determine next steps.

Date of Birth:*

Employer:

Work Phone:

Service Address

Date you want service started:*

Please select the current or a future date. To choose a date prior to today, please call Customer Service 24/7 at 360-992-3000.

Mailing Address

Co-occupant Information

Co-occupant's Social Security Number:*

Why do you need my SSN? Social Security numbers are required to start electric service and this website is encrypted and secure. If you do not have a social security number, please contact Customer Service at 360-992-3000 before submitting your form and a representative will help you determine next steps.

Spouse's Social Security Number:*

Why do you need my SSN? Social Security numbers are required to start electric service and this website is encrypted and secure. If you do not have a social security number, please contact Customer Service at 360-992-3000 before submitting your form and a representative will help you determine next steps.

Co-occupant's Date of Birth:*

Spouse's Date of Birth:*

Co-occupant's Employer:

Spouse's Employer:

Co-occupant's Phone:

Spouse's Phone:

Additional Co-occupant Information

Second Co-occupant's Social Security Number:*

Why do you need my SSN? Social Security numbers are required to start electric service and this website is encrypted and secure. If you do not have a social security number, please contact Customer Service at 360-992-3000 before submitting your form and a representative will help you determine next steps.

Second Co-occupant's Date of Birth:*

Second Co-occupant's Employer:

Second Co-occupant's Phone:

Additional Information

Any additional information you wish to provide: