Homeowner:  If you have purchased a home complete the form below to open a new account with EID.

Tenants: If you are a tenant, the homeowner will need to add you to their account by filling out an Owner/Tenant Billing Agreement

Fields marked with an asterisk* are required before you submit your request.

Service Address, and Contact, Identity, and Escrow Information

 *

Service Address, and Contact, Identity, and Escrow Information

First Name	Last Name
Service Address	City
Zip	Email Address
Primary Phone Numberext.	Alternate Phone Numberext.
Driver License or Social Security Number	Name of Title Company
Escrow Number	Close of Escrow Date

Notify me by text when my service address is affected by an emergency or repair.

Notify me by text when my service address is affected by an emergency or repair.

No	Yes, text me when my service address is affected by an outage or an emergency If other, type text here.

Mail bill to (if other than service address)

Mail bill to (if other than service address)

Address	City
State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip Code
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