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Get PA Application for Electric Service for Residential Customers

APPLICATION FOR ELECTRIC SERVICE FOR RESIDENTIAL CUSTOMERS For Office Use Only Account Number Customer Care Application Dept. If this application is not returned or the information provided is incorrect or fraudulent service will not be established. Applicant Social Security Number Joint Applicant Service Address Home Telephone Number City State Zip Code Business Telephone Number Turn ON Date Please list or correct the date from which you are responsible for service Mailing Address If different from Service Address List your Previous Home Address From To Address Electric and Gas Company Name Names Adult Occupants Landlord/Mortgage Holder Telephone Number Address of Landlord/Mortgage Holder If you are a landlord and this electric service is for your tenant please check this box Please fax or mail your completed application and copies of your valid picture ID mortgage deed or lease to the following Fax 412 393-5881 Mail Duquesne Light Company By submitting this application you are hereby authorizing Duquesne Light to check credit and employment history. 6-9 411 Seventh Ave. Pittsburgh PA 15219 IMPORTANT You must be 18 years or older to apply for service. Signature Date Signature Joint Applicant Call Duquesne Light at 412-393-7100 option 2-1-1 to pay your deposit or outstanding balance in certified funds no personal checks. If payment has been made fill out the payment section below. Deposit Amount Outstanding Balance Payment Reference Number Payment Method. Signature Date Signature Joint Applicant Call Duquesne Light at 412-393-7100 option 2-1-1 to pay your deposit or outstanding balance in certified funds no personal checks. If payment has been made fill out the payment section below. Deposit Amount Outstanding Balance Payment Reference Number Payment Method. .

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