Application for Service

Please complete this form to apply for NEW service only.  All requests received after 12 p.m. will be processed the next business day.

Note: All fields with the asterisk (*) are required. Incomplete applications will not be processed.  Information on this application will be used for the purpose of an Identity Check through Experian. Depending upon the results of your Identity Check, your application for service may be declined.

Please note that all applications for service are subject to approval and/or Identity Check. A customer service charge of $25.00 is required and will need to be paid at the time of application along with a security deposit if required. Any past due amounts to Overton Power District #5 must be paid in full before new service can be established.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
First Name:   *
Last Name:   *
Middle Initial:  
Social Security #:--  *
License State:  
Birth Date:    
Employer:  
Date of Birth:  

Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Please enter the physical address where service is required:
Service Address:  
Service Type (Construction Required or Existing Service):   *
If applicable, directions to new construction:  
E-mail:  *
Confirm E-mail:  *
Home Telephone #:--  
Cell Phone:--  
Spouse/Co Applicant Name: 
Spouse/Co Applicant Social Security #:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  
Spouse/Co Applicant Date of Birth:  

As one of our services, we provide an online application for viewing and paying bills. If you'd like to use this service, you can specify an Internet Password and Password Hint at this time. Please note that the Internet Password must be at least 6 characters in length.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Have you ever had service with us before?    
Account Number:

Deposit:  
Customer Service Fee:  

 
To the best of my knowledge, everything that is on this application is correct and I have read and agree to the Terms and Conditions of this service agreement.