Today's Date (required) Account Start Date MM/DD/YY (must be at least 2 business days from today and cannot be Friday, a weekend, or holiday) (required) Applicant First Name (required) Applicant Last Name (required) Applicant Phone (required) Applicant e-mail (required) Applicant Social Security Number (required) New Service Address (street) (required) New Service Address (city & zip) (required) Mailing Address (street) (required) Mailing Address (city, state, zip) (required) Previous Address (including city, state & zip) (required) Image of Driver's License (front only) (required) Current Employer Name & Phone # (required) Spouse or Co-Applicant Full Name Spouse or Co-Applicant Phone Spouse or Co-Applicant e-mail Spouse or Co-Applicant Social Security Number Spouse or Co-Applicant Driver's License Image Spouse or Co-Applicant Current Employer Name & Phone # Relative Reference Full Name & Phone # (not residing in the same home) (required) Relative Reference Relation (required) Father Mother Sibling Other Personal Reference Full Name & Phone # (required) Please provide your Landlord's Name, Address, Phone & E-mail *** Your Landlord will be required to sign a "Landlord Agreement" before we will process your application. New Account Deposit & Service Charge (required) Application Terms & Conditions: Release is hereby given to SESD to obtain any and all such information from employer(s) or references as may be deemed necessary to process this application for electrical service or for collection of any unpaid balance due. I agree to pay all amounts owed within 30 days of when such amounts are incurred. I agree to SESD sending a copy of my power bill to my landlord upon landlord's request. The terms of this paragraph shall apply to all amounts incurred by me or by any individual for whom I have legal responsibility whether such amounts are incurred today or after today. The undersigned, hereinafter referred to as CUSTOMER, applies to SESD, hereinafter called DISTRICT, for utility services. In consideration of the acceptance of this application by the District, and the rendering of such service, the Customer agrees and grants as follows: The Customer agrees to pay for such services in accordance with the rules and regulation and the applicable rates for such service now in effect or as the same shall lawfully be amended or changed from time to time. Customer agrees to pay all utility bills and charges associated with this account within twenty days after receipt of bill. It is understood that if the utility bill becomes 30 days delinquent, the utility service will be disconnected. Utility service shall not be restored until all delinquencies, reconnection fees, and any applicable deposits imposed are paid in full. Customer agrees to notify the District three (3) business days in advance of termination of service. The meter deposit will be applied to the final billing. Customer agrees to permit access to the District, its agents or employees, to enter the premises as described on the reverse side at all reasonable times for the purposes necessary and incident to rendering of such service. 6. Customer warrants that he/she has the authority to sign this agreement and to grant permission to the District to enter the premises. Customer agrees that he/she will make certain that the meters and equipment are readily accessible to the district and that there are no barriers or animals preventing reasonable access. Customer agrees to pay any damage to the meters or equipment excepting normal wear. Any notices to be given to the Customer shall be mailed or delivered to the Customer at the address listed on this agreement. Customer understands District absolves itself from any responsibility for damage to electric devices or appliances caused by power surges, bumps, outages, or acts of nature. CUSTOMER STATES THAT HE/SHE HAS READ ALL OF THE ABOVE PROVISIONS AND AGREES TO THE SAME. (required) Type Full Name to Agree to SESD's Terms & Conditions (required) Today's Date (required)
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