For the address you are moving to, are you:*field type radio button
For the address you are moving to, are you:Owner of propertyRenting property
Be prepared to provide proof of purchase, intent to purchase, or a lease agreement.
Upload proof of purchase, intent to purchase, or a lease agreement.*field type file upload
ADDRESS (you are moving to): (service provided by Dothan Utilities)*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date Service Requested (for new address):*field type date
Requests are processed Monday through Friday only. Dates selected for Saturday, Sunday or City Holiday will be processed for next available day of business.
ADDRESS (you are moving from): (service provided by Dothan Utilties)*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date Service to be Disconnected (address moving from)*field type date
Requests are processed Monday through Friday only. Dates selected for Saturday, Sunday or City Holiday will be processed for next available day of business.
**Will disconnect at 12 am on date selected**
First, Middle, Last Name:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Telephone Number:*(?)field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Driver's License Number:*(?)field type single line
Input blocked. Maximum character limit of 10 characters reached.
SSN:*(?)field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date of Birth:*(?)field type date
Email:*(?)field type email
Upload Copy Of Photo ID:*field type file upload
Note: The applicant hereby agrees to provide the City of Dothan, to the extent the applicant has interest, construction and maintenance easement, including ingress and egress, over, under, across, and upon the applicant’s property for the purpose of providing electrical and/or water service to the applicant. By signing the Application for Utility Service, the customer agrees to be responsible for payments for all billsincurred under this contract. The customer also agrees to maintain a sufficient deposit per the Code of Ordinances of the City of Dothan, Alabama. In the event that it becomes necessary to take action on a delinquent bill, the customer will be responsible for all collection fees, attorney’sfees, and court costs.
Electronic Signature Agreementfield type richtext

By checking the "I agree" box below, you agree and acknowledge that 1) the document will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Customer understands the electric service may terminate at 12 am on the date entered. It is recommended to select the first date you will not be in the residence as the termination date. Any service calls due to disconnection at midnight will result in a $65 after hours fee.
If you are requesting service and have not had Dothan Utilities in most recent 12 months, you may be subject to a consumer report through OnLine Utility Exchange to determine deposit required for the service account.
Customer Agreement for New Customer Application*field type checkbox
Customer Agreement for New Customer ApplicationI agree
Additional information/comments:field type multi line
Input blocked. Maximum character limit of 200 characters reached.
Applicant Signature*field type signature
Date Signed*field type date

City Of Dothan