Elm Ridge WCID - Artesia - Customer Portal
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Utility Service Application
Utility Service Application
Applicant Information
Check here if you are currently a customer of Elm Ridge WCID at another address:
Current Account:
*
Create Cut-off Service Order for Current Account?
Requested Turn Off Date:
*
Requested Turn Off Time:
*
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Social Security Number
Enter last 4 digits of SSN:
*
Please indicate type of account:
Residential:
Business:
Business Name:
*
First Name:
*
Middle Name:
Last Name:
*
Date of Birth:
*
Home Phone:
*
Mobile Phone:
*
Federal ID:
*
Work Phone:
*
Email:
*
Driver's License:
*
SSN:
*
Gender:
Ethnicity:
Race:
Name:
Home Phone:
Mobile Phone:
Work Phone:
Email:
*
Date of Birth:
*
Driver's License:
SSN:
Relationship:
Remove Co-Applicant
Please enter the address for which you are requesting service.
Address:
*
City:
*
State:
*
Zip Code:
*
Check if you own this residence:
Name of mortgage company: Name of landlord:
Check if your billing address is same as the service address:
If not, please enter your billing address
Address:
*
State:
*
City:
*
Zip Code:
*
Address:
City:
State:
Zip Code:
Requested Turn on Date for Utilities:
*
Requested Turn on Time for Utilities:
*
Name:
*
Phone No:
*
Address:
City:
State:
Zip Code:
Additional Comments:
Please attach required documents here:
Drag file here
Current Image:
Check here if you are currently a customer of Elm Ridge WCID at another address:
Current Account:
Create Cut-off Service Order for Current Account
Requested Turn Off Date:
Requested Turn Off Time:
Type of account:
First Name:
Middle Name:
Last Name:
Business Name:
Date of Birth:
Home Phone:
Mobile Phone:
Work Phone:
Email:
Driver's License:
SSN:
Federal ID:
Co-Applicant Information:
Name:
Home Phone:
Mobile Phone:
Work Phone:
Email:
Date of Birth:
Driver's License:
SSN:
Relationship:
Service Address:
Address:
State:
City:
Zip Code:
Check if you own this residence:
Name of mortgage company: Name of landlord:
Check if your billing address is same as the service address:
If not, please enter your billing address
Address:
State:
City:
Zip Code:
Previous Address:
Address:
State:
City:
Zip Code:
Requested Turn on Date for Utilities:
Requested Turn on Time for Utilities:
Name:
Address:
State:
Phone No:
City:
Zip Code:
Additional Comments:
By initialing, I agree to comply with all Utility rules, regulations, policies, and rates adopted by the Governing Board, including any future amendments. I understand I am responsible for all charges incurred at the service address and that failure to pay the full amount due may result in service disconnection. I further agree to pay any applicable collection costs, fees, and attorney’s fees associated with delinquent accounts. The Utility reserves the right to adopt, amend, and enforce policies, regulations, and bylaws governing utility service, and I agree to abide by them.
Initials:
Your application has been submitted. You will receive a notification whether it has been denied or approved once it has been processed and completed.
Your application number is
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