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Please correct the field(s) marked in red below:

All new applicants will require a soft credit check, unless you have established previous credit history with Glendale Water & Power.  A minimum security deposit of $100.00 may be charged on the first bill.

1
First Name
 *
2
Last Name
 *
3
Social Security Number
 *
4
Driver's License Number or Government ID Number
 *
5
Date of Birth
 *
6
Move In Date
 *
7
Service Address
Address City State Zip Code
Service Address
8
Mailing Address (If different than service address)
Address
City
State
Zip Code
9
Home Telephone Number
10
Mobile Phone Number
11
Name of individual(s) authorized to access account
12
Email Address
 *
13
 
 *

Joint Account Holder Information (if applicable)

14
First Name of Joint Account Holder
15
Last Name
16
Social Security Number
17
Drivers License Number or Government ID Number
18
Date of Birth
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