Orrville Utilities Service Application

APPLICATION INFORMATION

Name *

Driver’s Lic # *

Upload copy of Driver License

More information

Files must be less than 25 MB.
Allowed file types: gif jpg jpeg png pdf.

Date of Birth *

Month

Day

Year

SSN *

Email *

Phone Number Type *

Work Phone *

Landline Phone *

Cell Phone *

Add Secondary Phone Number

Secondary Phone *

New Service Address *

City *

State *

Connection Date *

Month

Day

Year

Own or Rent? *

Own

Rent

Please upload a copy of your Lease/Rent Agreement

More information

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Is this new construction? *

Yes

Do you want your statement mailed to an address different than your service address? *

Yes

Mailing Address

City

State

Zip Code

TRANSFERRING AN ACCOUNT? *

If this is NOT a new account, and you are moving, please complete if you wish to transfer your current Orrville Utilities Account.

TRANSFER FROM Service Address *

City *

State *

Zip Code *

Utility Account # *

(Enter last 6 digits of account number. Example XXXX-XX)

Disconnection Date *

Month

Day

Year

Owned or Rented? *

Owned

Rented

Landlord Name *

CO-APPLICANT INFORMATION

Do you wish to add a Co-Applicant to this account? *

Yes

A co-applicant on an account also assumes financial responsibility for payment of the utility account(s). A co-applicant has access to any information on the account and may request account changes.

Co-Applicant *

Driver’s Lic # *

Upload copy of Driver’s License

More information

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png.

Date of Birth *

Month

Day

Year

SSN *

Phone *

I certify and acknowledge all information above is valid and complete, and consent to a credit check by Orrville Utilities and hereby authorize Orrville Utilities to verify any of the above information, as deemed necessary. Additionally, I acknowledge agree and understand that I am liable for any amounts owed to Orrville Utilities for services provided to the above residence after the date of this Application. I also agree to permit Orrville Utilities to release usage and financial account information to the property owner or rental agent.

I acknowledge, agree and understand that if I have any outstanding delinquent utility accounts with Orrville Utilities, the delinquent balance can be added to my account and is my responsibility despite the fact that the utility bill delinquency may have been incurred in the past at a residence different from the above.

By signing my full name electronically, I certify that I have carefully read the above application, I understand it, and I agree and am subject to the conditions and terms written herein above.

Signature

Date *

Month

Day

Year

Leave this field blank

Orrville Utilities Service Application

I'm Looking For...