Apply for Residential Service

1
Application for Service
Service Requested
Customer Information
Mailing Address (if different from above)
Property Information
Are you the property owner?
Are you the tenant?(if yes, enter property owner info below)
Credit Information
If unemployedplease check
Identification
(2 pieces required (1 photo ID)
Previous Address
* A security deposit is required unless customer is enrolled in the Pre-Authorized Payment Plan (PAP). Credit reference from a previous utility is required for PAP.
OR
I have read and understood the statement (see reverse) of Lakeland Power regarding the contractual obligations, collection, use and disclosure of my personal information, and I hereby consent to have Lakeland Power collect and use my personal information for the purposes as stated.
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