Engineering Service Request

Billing Information
Name*

First NameLast Name
Co-Applicant Name (if applicable)

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Have you ever had service with Benton PUD?*

YesNo
(If no, or if your information cannot be located in our customer records, Benton PUD will contact you to obtain proof of identity.)

Acknowledgement
By selecting each of the below checkboxes, you acknowledge that you have read the following important information about your new Benton PUD account and/or Engineering Service Request:*

Benton PUD may require a deposit for electric service.A soft credit check will be conducted to determine credit worthiness and verify identity.When signing up for service at a new location, a Start Service fee will be added to the first monthly bill.Benton PUD rates and policies are approved by Benton PUD's Commission and are the governing documents under which customers receive electric service from Benton PUD. The policies can be found on our website at bentonpud.org. You can request a hard copy be mailed to you by calling Customer Service at (509) 582-2175.
I understand that entering my first and last name below constitutes a legal signature, and acknowledges that I have read the above information.
Signature*

First NameLast Name
Date*

YearMonthDay
Date
Please verify that you are human*
Should be Empty:

Service Location Information