All applications and forms can be sent to receptionist@avwsid.com

ELECTRONIC APPLICATION FOR UTILITY SERVICE

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SERVICE LOCATION

Address (required)

Service Begin Date (required)

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ACCOUNT INFORMATION

Owner/Tenant (required)

Owner

Tenant

Upload Lease Agreement or Owner Verification

First Name (required)

Last Name (required)

Business Name

Mailing Street/PO Box (required)

Mailing City (required)

Mailing State (required)

Mailing Zip Code (required)

Primary Phone Number (required)

Secondary Phone Number

Email Address (required)

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PAPERLESS BILLING

How would you like to receive your billing statement? (required)

Emailed Statement

Paper Statement

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SIGNATURE

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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