Step 1 of 2 0% Applicant InformationName(Required) First Last Date of Birth (mm/dd/yyyy)(Required) Month Day Year Social Security Number(Required) Government Issued ID Number(Required) State(Required) Service Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mailing Address(Required) Same as previous Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Phone Number(Required)Secondary Phone NumberEmail(Required) Meter Number Employer Work PhoneDo you have a co-applicant? Yes No Co-Applicant Information (all credit information is required to be added to account)Name(Required) First Last Date of Birth (mm/dd/yyyy)(Required) Month Day Year Social Security Number(Required) Government Issued ID Number(Required) State(Required) Primary Phone Number(Required)Secondary Phone NumberEmail Contact (Authorized to access account for inquiries only) Name First Last Phone Upload required documents here (ID, lease/deed, etc)Lassen Municipal Utility District (LMUD) is required by the Federal Trade Commission to validate the identity of all customers prior to providing service. This validation will require photo ID and Social Security Number. Qualifying photo ID shall include, without limitation, valid government-issued driver’s license or ID card, valid U.S. Permanent Resident Card, or valid passport. Drop files here or Select files Max. file size: 150 MB. Agreement & SignatureApplicant Consent(Required) I hereby verify the above information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.By signing, I am acknowledging that I have read and agree to the Terms and Conditions set forth in this application. I authorize LMUD to perform identity verification. I further authorize LMUD to conduct a credit check to determine eligibility for a waiver of the required deposit(s) in accordance with applicable policy(ies). By providing the telephone number(s) and/or email address(es) in this application, I consent to receiving autodialed and prerecorded voice message calls from LMUD or its 3rd party debt collector at that numbers(s) or email address(es). Lassen Municipal Utility District (LMUD) is required by the Federal Trade Commission to validate the identity of all customers prior to providing service. This validation will require photo ID and Social Security Number. Qualifying photo ID shall include, without limitation, valid government-issued driver’s license or ID card, valid U.S. Permanent Resident Card, or valid passport. No account shall be opened without identification validation. Applicant's Responsibilities I hereby request electric service to the address provided in the online application and agree to pay the applicable charges and abide by the rules and regulations of LMUD. I owe no monies to LMUD either directly or indirectly under the above name or any other name in which arrangements for payment in full have not been made. Service will only begin once prior balances have been paid. I understand that it is my responsibility to notify LMUD if I no longer wish to receive service. I acknowledge that I am responsible for any charges incurred until such notification has occurred. Applicant further agrees to pay all bills in accordance with the LMUD terms of sale. Should suit be brought or legal action taken on in same by an attorney or collections, applicant promises to pay a reasonable fee for such action, including all costs of the court and attorney’s fees to the extent found by the court to be reasonable under the circumstances. LMUD reserves the right to refuse or discontinue service if all of the above conditions are not accepted and required information is not furnished and/or the customer misrepresents the conditions for which service is being requested. Application Requirements Owners shall provide proof of ownership (i.e., copy of closing papers; copy of deed). The service will not be transferred or connected until the application and ownership documents are received and processed (minimum one to three business days). Renters must provide a signed copy of the rental/lease agreement. The service will not be transferred or connected until the application and rental/lease agreements are received and processed (minimum one to three business days). Deposit Requirements Determination for deposit requirements is based on the applicant’s and co-applicant’s credit history and the credit reporting agency’s evaluation of the potential for a credit risk (deposit will be equal to the last two months of the electric bill with a minimum being $200). If the credit qualifies, no deposit will be required. Deposits must be paid prior to service being connected. Deposits will be kept for a minimum of 12 months. It may be credited to the account when good credit has been established (e.g., no reminders or 48 hr notices), or when the account is closed. If the deposit has already been credited back to the account and the service is disconnected for non-pay, an additional deposit will be added back to account and must be paid prior to service being connected. Additional Fees $25 connect/transfer fee for all customers, this can be added to your first bill. $50 collection fee, for any account that has been “flagged” for collections, this fee will be added (even if your power has not been disconnected). $200 after-hours fee to reconnect for non-pay or to correct an issue that is not due to LMUD fault. (This fee would not be incurred during regular business hours.)Applicant & Co-Applicant Consent(Required) I hereby verify the above information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.By signing, I am acknowledging that I have read and agree to the Terms and Conditions set forth in this application. I authorize Lassen Municipal Utility District (LMUD) to perform identity verification. I further authorize LMUD to conduct a credit check to determine eligibility for a waiver of the required deposit(s) in accordance with applicable policy(ies). By providing the telephone number(s) and/or email address(es) in this application, I consent to receiving autodialed and prerecorded voice message calls from LMUD or its 3rd party debt collector at that numbers(s) or email address(es). LMUD is required by the Federal Trade Commission to validate the identity of all customers prior to providing service. This validation will require photo ID and Social Security Number. Qualifying photo ID shall include, without limitation, valid government-issued driver’s license or ID card, valid U.S. Permanent Resident Card, or valid passport. No account shall be opened without identification validation. Applicant's Responsibilities I hereby request electric service to the address provided in the online application and agree to pay the applicable charges and abide by the rules and regulations of LMUD. I owe no monies to LMUD either directly or indirectly under the above name or any other name in which arrangements for payment in full have not been made. Service will only begin once prior balances have been paid. I understand that it is my responsibility to notify LMUD if I no longer wish to receive service. I acknowledge that I am responsible for any charges incurred until such notification has occurred. Applicant further agrees to pay all bills in accordance with the LMUD terms of sale. Should suit be brought or legal action taken on in same by an attorney or collections, applicant promises to pay a reasonable fee for such action, including all costs of the court and attorney’s fees to the extent found by the court to be reasonable under the circumstances. LMUD reserves the right to refuse or discontinue service if all of the above conditions are not accepted and required information is not furnished and/or the customer misrepresents the conditions for which service is being requested. Application Requirements Owners shall provide proof of ownership (i.e., copy of closing papers; copy of deed). The service will not be transferred or connected until the application and ownership documents are received and processed (minimum one to three business days). Renters must provide a signed copy of the rental/lease agreement. The service will not be transferred or connected until the application and rental/lease agreements are received and processed (minimum one to three business days). Deposit Requirements Determination for deposit requirements is based on the applicant’s and co-applicant’s credit history and the credit reporting agency’s evaluation of the potential for a credit risk (deposit will be equal to the last two months of the electric bill with a minimum being $200). If the credit qualifies, no deposit will be required. Deposits must be paid prior to service being connected. Deposits will be kept for a minimum of 12 months. It may be credited to the account when good credit has been established (e.g., no reminders or 48 hr notices), or when the account is closed. If the deposit has already been credited back to the account and the service is disconnected for non-pay, an additional deposit will be added back to account and must be paid prior to service being connected. Additional Fees $25 connect/transfer fee for all customers, this can be added to your first bill. $50 collection fee, for any account that has been “flagged” for collections, this fee will be added (even if your power has not been disconnected). $200 after-hours fee to reconnect for non-pay or to correct an issue that is not due to LMUD fault. (This fee would not be incurred during regular business hours.)Requested Date to Start Service(Required) Applicant Electronic Signature (Full Name)(Required) Co-Applicant Electronic Signature (Full Name)(Required) Access to Meter Required(Required)LMUD requires that your meter is accessible to our field technicians. Please indicate that your meter is accessible, or if not, why. Meter is clear and accessible Locked gate or fence Dog or other animal Other (explain) Please let us know why your meter may not be accessible: