New Cash Customer Account Application

New Cash Customer Account Application

Main Electric Branch*

Main Branch you normally visit

Select

Main Employee*

Main Employee that assisted you today

Company Name*

First Name*

Last Name*

Office Phone

Phone

Mobile Phone*

Phone

Email Address*

Physical Address 1*

Physical Address 2

Apt, Unit, Suite, etc.

Physical City*

Physical State*

2 character State

Example: California = CA

Physical Zip Code*

5 number Zip Code

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