Residential Service Application

DATE OF SERVICE

Date Service Requested to Begin

Service connections require a minimum 24-hour notice.

ACCOUNT INFORMATION

This will be the billing address and contact information for the account.

Name(s) on Account

Main Contact Phone Number

Billing Address

Address 2

City/Town

State/Province

ZIP/Postal Code

PROPERTY LOCATION

This is where the electric service is located.

Property Location Same As Billing Address?

Yes

No

APN Parcel Number

Physical Street Address

Address 2

City/Town

State/Province

ZIP/Postal Code

APN Parcel Number

If property does not have street address, you must provide APN from Lincoln County parcel data.

RENTER INFORMATION

Complete this section only if renting.

Landlord Name

Telephone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

APPLICANT INFORMATION

Only the named individuals can make changes to the account.

Applicant One

Full Name

Date of Birth

Email

Drivers License

State

Phone Number

Phone Number
	Phone Number Type Phone Ext:	Item weight

more items

Best Method of Contact

Home Phone

Mobile Phone

Text

Email

Do you have a second applicant?

Yes

No

Applicant Two

Full Name

Date of Birth

Email

Drivers License

State

Phone Number

Phone Number
	Phone Number Type Phone Ext:	Item weight

more items

Best Method of Contact

Home Phone

Mobile Phone

Text

Email

SERVICE AGREEMENT

Lincoln County Power shall as soon as possible, deliver to the customer, the utility grade power for use on the premises occupied by the customer. Delivery shall be to the metering point.
The customer shall purchase from Lincoln County Power and pay monthly for all power used and shall comply with all rules, regulations, and rate schedules as set forth in Lincoln County Power Retail Policy.
The customer hereby grants Lincoln County Power the right to operate, repair, and maintain the electrical distribution equipment and service line located on the premises. The customer also grants the Lincoln County Power the right to cut or trim all trees necessary to ensure the safe and reliable operation of the electrical system.
Lincoln County Power will make every reasonable effort to furnish service under this agreement. Lincoln County Power shall not be liable to the customer for damages or for any delay or failure in furnishing service hereunder when such delay is caused by acts of the elements or for any cause out of the control of Lincoln County Power.
All lines, facilities, and equipment attached on the line side of the meter shall be owned and maintained by Lincoln County Power.
The customer shall provide Lincoln County Power with a deposit of $150.00 or an amount equal to two months highest bill, for a location, whichever is higher. Deposit requirements may be waived for customers with a good credit report.
The customer is responsible for all costs incurred for collection of delinquent accounts.
If a customer is a tenant, customer understands and acknowledges that Lincoln County Power may disclose, to the legal owner of the property, any information pertaining to providing service to the customer.
If customer is a landlord, customer understands and acknowledges that they must execute a guaranty of payment.
You agree, in order for us to service your account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or e-mails, using any e-mail address you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable.

Applicant One Signature

Sign above

Applicant One Signature Date

Applicant Two Signature

Sign above

Applicant Two Signature Date

Information below the line to be completed by Lincoln County Power District No. 1

Service Location

Service ID Number

Meter Number

STRONG PRINCIPLES RUN THROUGH LINCOLN COUNTY POWER LINES