APPLICATION FOR NEW UTILITY SERVICE

Customer Service - Finance Department

501 N. Anderson Street

Ellensburg, WA 98926

P. (509) 962-7201 | F. (509) 962-7130

Instructions

To apply for new utility service, please complete, sign and submit (online or print and deliver) this application. US Government-issued photo identification, such as a current driver's license, state ID, or passport, are needed to complete this application.

Deposit requirement. A utility deposit is required and must be paid at time the application is processed. This deposit is non-interest bearing, non-negotiable, and non-transferable to a second party. If the applicant has a utility account in their name, and has established 12 months of good payment history within the last 2 years, they may request a letter of credit from the utility company that verifies their payment history.

Connection of service can usually be made on the same weekday we receive the application, but not guaranteed. We do not connect service on weekends or holidays.

Questions? call (509) 962-7201 or (509) 962-7202.

First Name *

Last Name *

Spouse's First Name

Spouse's Last Name

Service Address *

Address Line 2

City *

State *

Zip Code *

Phone number - (Area Code) XXX-XXXX *

Is your mailing address and service address the same? *

Yes

No

If you answered no, provide your mailing address

Are you the *

Owner

Tenant

Owner and Tenant

Email Address *

Date service is to begin * +

US Gov't Issued Photo ID *

Document Number *

PLEASE NOTE: If you are completing this online form using the computer located in the lobby of Ellensburg’s City Hall, please click the 'choose file' button below and upload the file named "Lobby Computer" in response to the following question 'Upload copy of US Gov't issued ID'. After you submit the online form, show your ID to the customer service representative at the lobby counter. Thank you.

Upload copy of US Gov't issued ID *

Social Security Number *

Daytime Phone Number (format as (area code) xxx-xxxx) *

For additional security in protecting your identification, we now require each account holder to create a unique PIN to be used when speaking with a City of Ellensburg Customer Service Representative about their utility account. This PIN is needed if you want to ask questions about your utility account, such as what is my current bill. Because we value your security, we ask that you share this PIN only with others who will have a need to know your account information.

Each new account holder designates the replies to two security questions. Please select your first question from the dropdown list, and provide the answer to the security question. *

Answer to security question 1 *

New accounts are required to answer two security questions. Please select your second security question from the dropdown menu, and provide an answer to the question. *

Answer to security question 2 *

Input your 4-digit numeric PIN *

List a reference name, mailing address, and telephone number. This is an alternative mailing address. (Use the name of a relative or friend you keep in contact with.) *

Deposit requirement: A utility deposit is required and must be paid at the time the application is submitted. This deposit is non-interest bearing, non-negotiable, and non-transferable to a second party. If the applicant has a utility account in their name, and has established twelve months of good payment history within the last two years, the applicant may request a letter of credit from the utility company that verifies their payment history. *

I'll call you at (509) 962-7201 with a credit card for the deposit. I understand office hours are Monday-Friday 8:00 AM-noon, and 1:00-5:00 PM.

I'll use my credit card for the deposit. Please call me during business hours at the phone number listed in my application.

I'll stop by the utility customer service office at 501 N. Anderson during business hours to make my deposit.

I've had prior utility service, meet the good payment history threshhold, and would like a letter of credit.

Renewable Energy Rate Option. Renewable Energy is important to me. I'd like to pay $3/month to support renewable energy education and the maintenance of the Ellensburg Renewable Energy Park. If you'd like more information, visit https://ci.ellensburg.wa.us/index.aspx?NID=589 *

Yes, please sign me up!

No, thank you

It is agreed that venue shall be in Kittitas County, Washington, should any unpaid account balance be assigned for collection purposes as well as reasonable attorney fees and costs of collection. Customer signature recognizes agreement to conditions of City of Ellensburg ordinances. *

clear

Date * +