Test Page for General Application

I WANT TO....*

Start Service
End Service
Transfer Service (I'm Moving).

UTILITY SERVICE NEEDED*

Check all services that apply. Water and wastewater are available in limited areas only, and not in the City of Port Townsend.

Electricity
Water
Wastewater

UTILITY SERVICE NEEDED*

Check all services that apply. Water and wastewater are available in limited areas only, and not in the City of Port Townsend.

Electricity
Water
Wastewater
Broadband

CUSTOMER CLASS*

Residential
Commercial

CUSTOMER TYPE*

Owner
Renter
Property Owner/Manager

Before utility bills can be transferred into a tenant's name, the property owner or manager must fill out our Online Rental Property Service Authorization. All incoming renters must apply for service prior to their move in date. Service start dates will not be back dated. Property Owner or Manager may rescind or modify the Rental Property Service Authorization at any time by filing a new authorization form.

Account Number

Desired End Service Date*

date on which you no longer wish to receive PUD utilities to your current service address

Equipment Consent*

All JPUD equipment provided to the customer or end user must be returned to JPUD’s office in good working condition within 60 days. Failure to do so will result in a charge of $150 per piece of equipment. PUD staff will coordinate the pickup of JPUD equipment following the end of service.

I confirm I have read and understand equipment return requirements

Desired Service Start Date*

Date to begin receiving utility service from the PUD

Service Address*

location where utilities are installed and metered

Street Address and/or unit # City ZIP / Postal Code

New Service Address*

location where utility will be installed and metered after moving

Street Address and/or unit # City ZIP / Postal Code

Forwarding Address*

for End Service applications (final utility statements, additional information)

Street Address and/or unit # City ZIP / Postal Code

New Service Address: Own or Rent?*

Will you be renting or do you own the residence or premises you want the service transferred to?

Own
Rent

Company or Organization Name*

Phone*

Fax

Company or Organization Email

Federal ID #

Date of Incorporation

Primary Contact Name*

First Last

Email*

Enter Email Confirm Email

Primary Phone*

(home or mobile or work)

Secondary Phone

(home or mobile or work)

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Secondary Contact for Account

Do you wish to list or remove any one else as a representative for your account? This person can access account data and pay bills.

Yes
No
Remove

Secondary Contact Name

Add or remove a Secondary Contact by entering their name here.

First Last

Please Upload 2 Copies of ID

1 form of Primary ID: Drivers license or passport preferred. 1 form of Secondary ID showing name and address. Cell phone photos of ID are acceptable to upload.

Drop files here or

Accepted file types: jpeg, jpg, gif, png, pdf, heic, Max. file size: 20 MB, Max. files: 2.

Please Upload Photo of ID*

Drivers license or passport preferred. Cell phone photos of ID are acceptable to upload.

Drop files here or

Accepted file types: jpeg, jpg, gif, png, pdf, heic, Max. file size: 20 MB, Max. files: 2.

Secondary Contact ID*

Drivers license or passport preferred. Cell phone photos of ID are acceptable to upload.

Accepted file types: jpeg, jpg, gif, png, pdf, Max. file size: 20 MB.

Forwarding Address

Do you need future correspondence to be forwarded to a new address? If yes, please enter the new address below.

Yes
No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Comments or Questions?

Please add any additional comments or requests in the space below.

Consent*

With Customer(s) signature and acceptance by the District, the application becomes a contract committing the Customer(s) to pay for utility services at the above location at the applicable and established rates and minimum charges, and for any unpaid services previously rendered to the Customer(s) by the District. The Customer(s) agree to be governed by the policies and Resolutions of the District which includes providing safe access to PUD property by PUD employees as required. Breach of contract by the Customer(s) shall obligate the Customer(s) for all loss suffered by the District by reason thereof. In addition, the Customer(s) hereby grants authorization to the District to check credit and utility history, and understand a deposit may be required prior to service. The Customer(s) agree that the information in this application is true and correct to the best of their knowledge. District policies can be found at www.jeffpud.org/policies. Print copies will be made available upon request.

Check to Agree to District Application Policy

Signature*

Read the Full Customer Service Policy Online or Request a Copy from Customer Service Link to Customer Service Policy

Consent

I agree to the privacy policy.

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.

Test Page for General Application

General Service Application (BB update 11.24)