New Residential Service Application (Secure Form)


Note: Online service requests are processed from 8a.m.- 5 p.m. Monday through Friday. A minimum of 3 business days is required before service can be established. Online service requests can be made a maximum of 90 days in advance. If a deposit is not required and there is no further information required, you will receive an email confirmation of your request and the service connection date. Please make sure to add EnergyUnited to your spam folder settings.



*Denotes Required Fields

Applicant Information


First Name*  
MI
Last Name*  
Billing Address*  
City, State, Zip*  
Home Phone*  
(Is this a cell phone?)
Cell Phone

It is important that EnergyUnited has the correct phone number on-file for your account. Phone numbers are used to quickly access account information, report outages via our automated system, notify our members of any planned interruptions in service, as well as to contact the member. By submitting your number above, you agree that EnergyUnited may contact you at the number provided either by telephone or via our automated outbound messaging system. I agree it is my responsibility to contact EnergyUnited if my phone number changes or I no longer wish to receive information via phone or text.

I agree
 
Email Address*    
Confirm Email Address*    
Social Security Number*    
Do you have a Driver's License?
Drivers License* State of Issuance
License Number  
Are you a former EnergyUnited member?


Will there be a co-applicant?
If Yes, please contact Customer Care at 800.522.3793 Monday-Friday 7a.-8p


Authorized Person on Account Information


(Person is not listed as a co-applicant but may inquire on account information)

Do you want to add an authorized person to your account?


Service Location Information


Is this new or existing service?
Service Start Date*  
Service connections can be scheduled Monday-Friday, excluding holidays) Allow three business days to complete the application
Service Location Address*  
Apt/Lot Number (if applicable)
City, State, Zip*  
Own/Rent*  
Daytime Phone
Outside Light(s)
if yes, do you wish to keep the light?


Residence Information


Home Type*  
Home Square Footage*  
Type of Heat*  
What type of air conditioning do you have?*  
Multiple Heat Pumps*  
Number of Heat Pumps  
Water Heater*  
Propane*  
Provider Name
Generator*  
Generator Type  


Billing Information


Bills will be sent electronically to the email address provided above. If you prefer paper billing, check here. Paper Billing
Enroll in bank draft program Y/N
Bank Name
Name On Account
Account Type
Bank Routing Number
Bank Account Number


Offers To Enhance Your Membership


Contact me about the following...
Propane Products & Services
Triple Surge Guard
Generators


Terms & Conditions


I agree to the EnergyUnited Service Rules and Regulations and to the best of my knowledge the application is accurate and complete*
To view the EnergyUnited Service Rules and Regulations Click Here
To view the EnergyUnited Member Guide Click Here
Fees*
I agree
 
A $5.00 membership fee and the applicable connection fee will be included in your first bill.
Deposits*
I agree
 

Identify verification and deposits are determined by a personal credit check through Online Utility Services. If a deposit is required, you will be contacted by a customer care representative to discuss deposit options.

Note: If you choose to submit any information via EnergyUnited’s secure online form, please be advised that the information has been encrypted for security purposes. However, the electronic submission of personal identifying information (driver’s license number, Social Security Number, or other information) may be subject to inadvertent disclosure due to the nature of the technology. Any provision of personal identifying information is at your own risk and no guarantee or warranty of privacy or confidentiality, express or implied, is provided by EnergyUnited.

Complete all required fields and click Submit to send your application.


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