Service Application

LinkedFromSource
Account Type
Account Type*
How are you associated with this property?*
Landlords authorize Public Utility District No. 1 of Lewis County (District) to re-establish service in the Landlord’s name without further notification to the Landlord. The re-establishment of service will occur at the time the tenant terminates services with the District.

The meter will remain connected and the Landlord will be responsible for any daily basic and electrical consumption charges accrued between the vacating tenant and the new tenant.

The Landlord agrees to notify the District in writing of any changes in property ownership.

The District reserves the right to disconnect service for non-payment or for emergency purposes.

Failure by Landlord to make on-time payments will result in removal of the Landlord option.

The District will bill a $10.00 fee (Account Service Charge) each time service is established, or account responsibility is transferred to the Landlord.
I have read and agree to the above landlord notice.*
- Yes
Customer Information
Full Legal Name of Primary Account Holder*
Type NMI for No Middle Name if necessary
First Middle Last
Business Name*
Full Name of Applicant*
Type NMI for No Middle Name if necessary
First Middle Last
Title*
Specify Other Title*
Phone*
Cell Phone
Email Address*
Driver License Number of Primary Account Holder*
State of Issuance for Driver License*
State
Social Security Number:*
Last 4 digits only
Date of Birth*
Date Format: MM slash DD slash YYYY
Employer of Primary Account Holder
Work Phone
Full Name of Other Responsible Party*
Type NMI for No Middle Name if necessary
First Middle Last
Relationship*
Joint Account Holder Social Security Number*
Last 4 digits only
Joint Account Holder Driver License Number*
Joint Account Holder Driver License State of Issuance*
State
Joint Account Holder Phone Number*
Joint Account Holder Email
Joint Account Holder Name of Employer
Joint Account Holder Work Phone Number
Joint Account Holder Date of Birth*
Date Format: MM slash DD slash YYYY
Business License Number*
Federal Tax ID Number*
Service Location Information
Address*
Street Address (Include Apartment or Suite Number) Address Line 2 City State ZIP Code
Is the mailing address different than the service address listed above?*
- No
- Yes
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Existing Meter Number (Optional)
Requested Activation Date*
We do not provide same day reconnects for online requests. Online service application requests must be made at least 3 days prior to the effective date of the transfer or reconnect.
Date Format: MM slash DD slash YYYY
Does the PUD need a key or code for access?*
If any LCPUD equipment is located within a locked enclosure, the District shall be furnished with a key or code for access.
How would you like to provide the code or key?*
Code or Combination Number*
Are there any outdoor animals the meter readers should be aware of?*
Type of animal*
Date*
Date Format: MM slash DD slash YYYY
The applicant is subject to all of the provisions of the District resolutions establishing service policies and rates, which are by this reference incorporated into and made a part of this application. This application, when accepted by the District, becomes a contract committing the Applicant/Customer to pay for the electrical service furnished in accordance with the applicable rate schedules, including minimum charges, and for any unpaid service and charges previously rendered to the Applicant/ Customer by the District.
A non-refundable Account Service Charge (ASC) of $10.00 will be billed on your first statement.
By submitting or signing this document I hereby authorize Lewis County PUD to check credit and utility history. This soft utility credit report does not affect your credit score. It is used only to determine the deposit requirement for the applicant(s). A Social Security Number is required to complete the credit check for online applicants who do not have a current credit history with Lewis PUD. Upon receipt of the application, a Customer Service Representative will contact the applicant(s) to obtain the 9 digit SSN and run the credit check. If the applicant prefers not to provide a SSN they will be considered high risk and the maximum deposit requirement for the location type will be assessed at that time. If it is determined that a security deposit is not required at the time of application, LCPUD reserves the right to collect a deposit at any time should the payment history become unsatisfactory, or the account status becomes delinquent..
If you do not hear from an LCPUD CSR within 2 business days of your submitted application, please call our customer service department at 360-748-9261 or 1-800-562-5612.

I hereby verify the information provided on this form to be true and complete. I understand that by typing my full name below and submitting this information, this form will be stamped with today’s date and authorized by me as if I had signed my signature. I certify under penalty of perjury of the state of Washington that I am the individual named in the electronic signature block.
Full Name of Applicant*
By typing your name below you agree that all information provided is correct and that you have read, acknowledge and agree to all of the terms and conditions of service listed above.
Full Name of Joint Applicant*
By typing your name below you agree that all information provided is correct and that you have read, acknowledge and agree to all of the terms and conditions of service listed above.
Questions & Comments
Identification Upload*
Attach a copy of valid government issued photo identification for all responsible parties. Acceptable forms of ID include:
- *Valid State Driver’s License or ID Card
- *Passport
- *Military ID
For Corporate accounts only: In lieu personal government issued identification, we will accept:
- *Company photo ID with a Letter of Authorization on Company letterhead.
Drop files here or
Service Application Terms and Conditions*
- I have read the Terms and Conditions
Customer Informational Brochure*
- I have read the 2021 Customer Informational Brochure.
Comments
This field is for validation purposes and should be left unchanged.

Service Application

Account Type

Customer Information

Service Location Information

At your service.

CHEHALIS

MORTON