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Test Page for General Application
General Service Application (BB update 11.24)
I WANT TO....
*
Start Service
End Service
Transfer Service (I'm Moving).
UTILITY SERVICE NEEDED
*
Check all services that apply. Water and wastewater are available in limited areas only, and not in the City of Port Townsend.
Electricity
Water
Wastewater
UTILITY SERVICE NEEDED
*
Check all services that apply. Water and wastewater are available in limited areas only, and not in the City of Port Townsend.
Electricity
Water
Wastewater
Broadband
CUSTOMER CLASS
*
Residential
Commercial
CUSTOMER TYPE
*
Owner
Renter
Property Owner/Manager
Before utility bills can be transferred into a tenant's name, the property owner or manager must fill out our
Online Rental Property Service Authorization
. All incoming renters must apply for service prior to their move in date. Service start dates will not be back dated. Property Owner or Manager may rescind or modify the Rental Property Service Authorization at any time by filing a new authorization form.
Account Number
Desired End Service Date
*
date on which you no longer wish to receive PUD utilities to your current service address
MM slash DD slash YYYY
Equipment Consent
*
All JPUD equipment provided to the customer or end user must be returned to JPUD’s office in good working condition within 60 days. Failure to do so will result in a charge of $150 per piece of equipment. PUD staff will coordinate the pickup of JPUD equipment following the end of service.
I confirm I have read and understand equipment return requirements
Desired Service Start Date
*
Date to begin receiving utility service from the PUD
MM slash DD slash YYYY
Service Address
*
location where utilities are installed and metered
Street Address
and/or unit #
City
ZIP / Postal Code
New Service Address
*
location where utility will be installed and metered after moving
Street Address
and/or unit #
City
ZIP / Postal Code
Forwarding Address
*
for End Service applications (final utility statements, additional information)
Street Address
and/or unit #
City
ZIP / Postal Code
New Service Address: Own or Rent?
*
Will you be renting or do you own the residence or premises you want the service transferred to?
Own
Rent
Company or Organization Name
*
Phone
*
Fax
Company or Organization Email
Federal ID #
Date of Incorporation
Primary Contact Name
*
First
Last
Email
*
Enter Email
Confirm Email
Primary Phone
*
(home or mobile or work)
Secondary Phone
(home or mobile or work)
Billing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Secondary Contact for Account
Do you wish to list or remove any one else as a representative for your account? This person can access account data and pay bills.
Yes
No
Remove
Secondary Contact Name
Add or remove a Secondary Contact by entering their name here.
First
Last
Please Upload 2 Copies of ID
1 form of Primary ID: Drivers license or passport preferred. 1 form of Secondary ID showing name and address. Cell phone photos of ID are acceptable to upload.
Drop files here or
Select files
Accepted file types: jpeg, jpg, gif, png, pdf, heic, Max. file size: 20 MB, Max. files: 2.
Please Upload Photo of ID
*
Drivers license or passport preferred. Cell phone photos of ID are acceptable to upload.
Drop files here or
Select files
Accepted file types: jpeg, jpg, gif, png, pdf, heic, Max. file size: 20 MB, Max. files: 2.
Secondary Contact ID
*
Drivers license or passport preferred. Cell phone photos of ID are acceptable to upload.
Accepted file types: jpeg, jpg, gif, png, pdf, Max. file size: 20 MB.
Forwarding Address
Do you need future correspondence to be forwarded to a new address? If yes, please enter the new address below.
Yes
No
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Comments or Questions?
Please add any additional comments or requests in the space below.
Consent
*
With Customer(s) signature and acceptance by the District, the application becomes a contract committing the Customer(s) to pay for utility services at the above location at the applicable and established rates and minimum charges, and for any unpaid services previously rendered to the Customer(s) by the District. The Customer(s) agree to be governed by the policies and Resolutions of the District which includes providing safe access to PUD property by PUD employees as required. Breach of contract by the Customer(s) shall obligate the Customer(s) for all loss suffered by the District by reason thereof. In addition, the Customer(s) hereby grants authorization to the District to check credit and utility history, and understand a deposit may be required prior to service. The Customer(s) agree that the information in this application is true and correct to the best of their knowledge. District policies can be found at www.jeffpud.org/policies. Print copies will be made available upon request.
Check to Agree to District Application Policy
Signature
*
Read the Full Customer Service Policy Online or Request a Copy from Customer Service
Link to Customer Service Policy
Consent
I agree to the privacy policy.
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.
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