Engineering Application for Service

Engineering Service Request

For questions, contact EngService@bentonpud.org or call (509) 582-1230
Service Location Information
Service Address

Street Address

Street Address Line 2

CityState

Zip Code
Subdivision/Plat
(optional)
Lot
(optional)
Block
(optional)
Parcel/Tax ID#
(optional)

Billing Information
Is the applicant a person or a business?
UBI#
Billing Name
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Co-Applicant Name (if applicable)
Co-Applicant Email
example@example.com
Co-Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Has either applicant ever had previous service with Benton PUD?
(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:
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:

Engineering Service Request