Start Service - Clark Public Utilities

General Primary Account Holder Information

Please select one of the following:*

I am buying this home
I am renting this home or apartment
I am renting out a home that I own
I am managing this home/apartment for the owner

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.

Name of person filling out this form on behalf of tenant:*

First Last

Name on Utility Account:*

First Last

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

Service Address:*

Street Address Address 2 (Unit/Apt/Suite #) City State ZIP Code

Date you want service started:*

Mailing Address

Is your mailing address different than your service address?*

Yes
No

Mailing Address:*

Street Address Address 2 (Unit/Apt/Suite #) City State ZIP Code

Co-occupant Information

Would you like to add additional household members to the account?*

Yes
No

Is the household member a spouse?

Yes
No

Co-occupant's Name:*

First Last

Spouse's Name:*

First Last

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 Work Phone:

Spouse's Work Phone:

Would you Like to add an additional co-occupant?

Yes
No

Additional Co-occupant Information

Second Co-occupant's Name:*

First Last

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 Work Phone: