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Finance and Utilities Department
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Finance & Utilities: Establish New Service
Finance & Utilities: Establish New Residential Service Only
Application Date
(Required)
Turn On Date
(Required)
Residence Type
(Required)
Rent/Lease
Own
New Construction Temporary Service (Provide Building Permit Number Below)
Non-Residential (Provide Zoning Compliance Number Below)
New Construction Temporary Service Building Permit Number
You will also need to make an appointment with Planning & Inspections.
Non-Residential Zoning Compliance Number
You will also need to make an appointment with Planning & Inspections.
Upload Driver's License & Proof of Lease/Ownership
(Required)
Drop files here or
Select files
Max. file size: 10 MB.
For Lease: Upload only tenant responsibilities and signature pages. For Ownership: Upload only Deed, or front page of Settlement Statement.
Requested Services from Utility Company (Check all that apply)
(Required)
Electric
Select All
Name(s)
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Driver's License Number
(Required)
Date of Birth
(Required)
SSN
(Required)
Please enter a number from
0000000000
to
9999999999
.
*** By providing your social security number it will be used to facilitate credit reports and collection of electric, recycle/yard debris, privilege licenses & property taxes or any other bills in the event you do not pay the bill(s) voluntarily. Using the provided social security number will also allow the city to claim payment on any unpaid bill from the NC Debt Setoff Program and/or other collection methods necessary to satisfy any unpaid debt.
Service Address
(Required)
Service Address
Address Line 2
City
State / Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing Address
(Required)
Mailing Address
Address Line 2
City
State / Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
(Required)
Alternate Phone Number
Prior Utility Company
(Required)
If none, write N/A.
Consent
(Required)
I hereby make application for utility services as indicated and the premises indicated. I agree to comply with the applicable ordinances of the city of Southport regarding the provision of utility services, including those relating to deposits and other charges. I understand that the information furnished on this application will be verified and if determined inaccurate, will result in the termination of service without prior notice.
Consent
(Required)
I understand that if water, sewer, and/or irrigation is applicable, I, the applicant, will need to contact Brunswick County Public Utilities at (910) 253-2655 (option 2 or 3) or email at utilitybilling@brunswickcountync.gov to establish service.
Customer Signature
(Required)
Today's Date
(Required)
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