Please complete this form to apply for electric service. Service requests are processed during normal business hours (Monday through Friday, 8am to 5pm). 

Residential applicants are required to provide Copy of Picture ID.  Please email a copy of your ID to customerservice@nwascopud.org.

Commercial applicants are required to provide 1) Copy of Picture ID and/or 2) Business Card. Please email a copy of either to customerservice@nwascopud.org.

If you have any questions regarding service, please feel free to contact us via email at customerservice@nwascopud.org or contact our office (541) 296-2226.

Note: All fields with the asterisk (*) are required. Incomplete applications will not be processed.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
Last Name:		   *
First Name:   *
Middle Initial:  
Social Security #:--  *
Driver's License #:  *
Driver's License State:   *
Date of Birth:  *  
Previous Address:
Street Address:		  
City, State:  
Zip Code:  

Mailing Address:
Please provide the address where bills should be sent.
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please provide the physical address.
Service Address:  
Service Type (Construction Required or Existing Service):  
Comments:  
E-mail:  
Confirm E-mail:  
Home Phone:--   *
Cell Phone:--  
Work Phone:--   
Spouse or Co Applicant Information:
Name:		 
Social Security #:-- 
Driver's License #:  
Driver's License State:  
Date of Birth:    
Additional Contact Information:
Name:		  *
Phone Number:  *

Online Access:
We offer a portal for online bill payment and account management. If you would like access to your account online, please create a password and password hint below. Please note passwords must be a combination of letters and numbers.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing/Previous Service:
Have you had service with a PUD before?    
Account Number:
Fee/Deposit Information:
The amount of deposit is based on credit history verification. Please be prepared to pay a $25.00 Account Processing Charge with your first bill. Once your account has been officially created in our system, you will receive a new account information email, including a total amount due on your new account, also including deposit amount (if applicable).

Account Processing Charge:  

Would you like to participate in Operation Round Up?   *
Please select preferred Billing Method:   *
 
THE APPLICANT(S) HEREBY AGREE TO THE FOLLOWING CONDITIONS AND/OR STIPULATIONS.  I/WE HEREBY CERTIFY THAT THE FOREGOING INFORMATION IS TRUE TO THE BEST OF MY/OUR KNOWLEDGE.  
I understand that checking this box and typing my name in the field provided below is my electronic signature. Signer has read, understands and accepts the stipulations and agreements. The undersigned hereby guarantees payment for the electric service provided.
  Applicant Name:     *