Application for Utility Service
Residential

The undersigned hereby applies for utility service and agrees to purchase all such services from Public utility District No. 1 of Klickitat County (the "PUD") upon the following terms and conditions

  1. Applicant will pay the PUD the sum of $ as a service deposit, which amount shall be retained by the PUD and may be applied by the PUD to Applicant's account(s) in accordance with the rules, regulations and policies of the PUD.

  2. Applicant will purchase from the PUD utility services used on the premises by Applicant or others, and agrees to pay all utility bills promptly, or suffer disconnection if not paid in accordance with the rules and regulations of the PUD. If Applicant is a corporation, the undersigned principal shareholder(s) of Applicant hereby personally guarantee(s) payment to the PUD of any amounts owned by the Applicant.

  3. If Applicant has more than one account for utility service by the PUD, or uses utility service on more than one account (regardless of the name of the account), Applicant agrees that delinquent amounts due the PUD on any such account may, at the discretion of the PUD, be transferred to any other such account, even if such transfer would render such other account delinquent.

  4. Applicant agrees to comply and be bound by such rules, regulations and policies as may be established by the Board of Commissioners of the PUD. Applicant may obtain information from any office of the PUD as to such rules, regulations and policies.

  5. Not more than $4.50 of the money paid annually to the PUD on the Applicant's utility bill is for a year's subscription to Ruralite Magazine. The PUD complies with State and Federal laws governing nondiscrimination.

Signed: Date:
Account Number:
Mailing Address:
**Phone Number:
Former Residence:
Present Employer:
Present Employer Address:
Former Employer:
Former Employer Address:
Nearest Living Relative:
Nearest Living Relative Address:
Credit References:
** = This is a mandatory field. Form will not submit without it.