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New Service Application

2. New Service Application

3. Are you a Renter or Owner?*

   1. Renter
   2. Owner

5. First Name*

6. Last Name*

8. Phone Number*

9. Email Address

11. Requested Service Address*

13. What day do you want your service started?*
    What day do you want your service started?

14. NOTE: Customer Service will contact you once we receive your application. If your application is received after 3:00 pm, your service will not be started until the next business day. Also, a copy of your drivers license and social security card must be received prior to your service starting.*

    1. I understand.
16. If mailing address is different than your service address enter below.

18. Address

20. City

21. State

22. Zip Code

24. Driver's License Number*

25. Driver's License State*

27. Social Security Number*

29. Please provide any additional comments or information below.

31. New Account Activation Fee*

    1. I Understand

    When starting a Utility Account there is a $50.00 Non-Refundable Activation Fee for all accounts that will be charged on your first bill. This fee is a one-time charge and will not be on any bills following your first one. By checking the box below you are accepting that you understand and acknowledge this fee.

33. Renter Security Deposit

    1. I Understand

    When "RENTERS" start a Utility Account there is a $150.00 Security Deposit charged for all accounts that will be charged on your first bill. This deposit will remain on your account until your account closes. By checking the box above you are accepting that you understand and acknowledge this fee.

35. Proof of Ownership Documents

    In order to have homeowners' deposit of $150 waived, your proof of ownership MUST be provided. Proof of ownership can consist of deed, mortgage statement, etc. Please upload a copy of this document here.

37. Copy of Driver's License*

    Prior to utility service being connected, the applicant must provide a valid driver's license. Please upload a copy of this document here.

39. Copy of Social Security Card*

    Prior to utility service being connected, the applicant must provide a valid social security card. Please upload a copy of this document here.

41. New Customer Agreement*

    1. I Accept The Terms Below

    By checking the box above you agree to the following terms: I agree that the information provided is accurate and that I am the individual associated with this information. I agree to submit this information to the City of Lowell in North Carolina and understand that this information will be used to start a Utility Account under the information I provided. I understand that I will be held financially responsible for any charges associated with starting this Utility Account with the City of Lowell in North Carolina. Should any of the information that I provided be found to be false, I will pay the associated fees and penalties to have this information corrected.

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field