Clatskanie PUD > Account Info > Start or Stop Electric Service > Start Electric Service > Co-Applicant Application Form

Co-Applicant Application Form

How to Apply to an Existing Customer Account:

Come by our office.
By completing the Co-Applicant Application Form below.

Office Address: 495 E. Columbia River Highway Clatskanie, OR 97016
Email: customerservice@clatskaniepud.com

When applying in person, please bring one piece of unexpired, government-issued identification with photograph. The District will accept all forms of identification approved by the U.S. Department of Homeland Security and/or the U.S. Transportation Security Administration.

A Social Security Number is required to complete the soft credit check for applicants who do not have a current credit history with Clatskanie PUD (District). Soft credit checks DO NOT impact your credit score; it is solely used to determine your Security Payment.

Service Location Information
Address*
Address including Apartment or Suite Number City State ZIP Code
Primary Account Holder Information
Existing Account Holders Legal Name*
First Middle Last
Account Number
Phone*
Email*
Customer Information
Full Legal Name of Applicant*
First Middle Last
Phone*
Secondary Phone
Email*
Driver License Number*
State of Issuance for Driver License*
Social Security Number*
Date of Birth*
Month
Day
Year
Employer*
Mailing Address*
Mailing Address City State ZIP Code
Identification Upload*
Attach a copy of valid government issued photo identification for all responsible parties.
Acceptable forms of ID include: Valid State Driver License or ID Card, Passport, and Military ID.

For Corporate accounts only: In lieu of personal government issued identification, we will accept company photo ID with a Letter of Authorization on Company letterhead.
Drop files here or

Accepted file types: jpg, jpeg, pdf, png, tiff, Max. file size: 20 MB.
Electric Service General Terms & Conditions*
By checking this box, I acknowledge that I have read and agree to the Electric Service General Terms & Conditions.
- I have read and accept the District's Electric Service Agreement Terms & Conditions.
Do you consent to signing this document electronically?*
- Yes
- No; Please contact Customer Service for more information.
Full Name (Digital Signature)*
I hereby verify the information provided on this form to be true and complete. I understand that by typing my full name below and submitting this information, this form will be stamped with today's date and authorized by me as if I had signed my signature. I certify under penalty of perjury of the state of Oregon that I am the individual named in the electronic signature block.

Co-Applicant Application Form

How to Apply to an Existing Customer Account:

Service Location Information

Primary Account Holder Information

Customer Information

ADDRESSES

OFFICE HOURS

PHONE NUMBERS

SOCIAL MEDIA