Request Service/Transfer Service

Application for Service

First Name *

Middle Initial *

Last Name *

Social Security Number *

Phone

Service Address *

Service Address

City

State/Province

Zip/Postal

Mailing Address

City

State/Province

Zip/Postal

911 Registration *

Maximum upload size: 268.44MB

Upload your 911 Registration Form here. This form is required in order for service to be connected at your location.

Marital Status *

Spouse Name (First, Middle, Last)

Dwelling *

If a trailer, please provide the Tax-ID

Own / Rent *

Current Employer *

Employer Address

City

State/Province

Zip/Postal

Employer Phone

Choose PayWise Prepaid Option *

Yes

PayWise prepaid electricity offers a solution to our members which allows them to pay in advance for their electric consumption. This option will avoid the requirement of a deposit.

PayWise Email

PayWise Text Notification Number

Outdoor Light *

Yes

I wish to request an Outdoor Light at my service location. I understand that the Outdoor Light will require a contract, which will be emailed to the email address provided above.

Request Deposit Waiver *

Yes

I hereby authorize ACEPA to request a credit report from the Online Utility Exchange in order to decrease the amount of the deposit that I am required to maintain with the Association.

ACEPA Policy on Identity Theft and Fraud *

Yes

In order to comply with the FactACT of 2003, ACEPA will use techniques to detect and monitor identity theft within the Association. Any suspicious act may be investigated in accordance with ACEPA's policy on Red Flag compliance and may be reported to the proper investigating authorities. By checking "Yes", I hereby certify that the information that I have submitted is correct and accurate.

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