Residential Electric Application

Service Address

Service Address Mailing Address (If Different) APT / LOT City State Zip Code Previous Address Previous Electrical Supply Company Name of person(s), other than applicant(s), whom you authorize account details on your behalf

Reedsburg Utility requires positive identification. A service deposit may be required as allowed by the Wisconsin Public Service Commission. Before service can be furnished, this application must be completed in full and submitted to Reedsburg Utility Commission. Missing, incomplete or fraudulent information may delay service. By signing this application for service, the applicant(s) named above hereby authorizes Reedsburg Utility Commission to: 1) Provide the property owner or their authorized agent(s) notification of any past due charges. 2) Contact previous electric company for a letter of credit.

The undersigned warrants that the information on this application is true and provided without intentional omission.

Applicant #1 Signature Date

Applicant #2 Signature Date

By signing this application for servicing the property owner/landlord hereby attests that the applicant(s) names above is responsible for payment of the utility charges provided at the service address listed above.

Name of Property Owner Property Owner Phone Number Property Owner Mailing Address City, State, Zip Property Owner Signature