Instructions to Applicants
As part of the Dothan Utilities application process, we obtain a consumer report through OnLine Utility Exchange on all new applicants. As a result, we are requesting you fill out and sign this Application for Service to process the consumer report and verify responsibility for service. Deposits range from $100 to $500 depending on credit history.
Customers do have the option to select Prepay service, when available.
ADDRESS (for which you are requesting service):*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Are you:*field type radio button
Are you:Owner of propertyRenting property
Be prepared to provide proof of purchase, intent to purchase, or a lease agreement.
Are you interested in our prepay program?*field type radio button
Are you interested in our prepay program?YesNo
Upload proof of purchase, intent to purchase, or a lease agreement.*field type file upload
Date Service Requested:*field type date
Requests for initiation are processed Monday through Friday only. Dates selected for Saturday, Sunday or City Holiday will be processed for next available day of business.
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 20 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.
Connection Fees: $25.00 before 12:00pm, $35.00 after 12:00pm
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