Residential Registration Are you or have you ever been an existing member with Dixie Power?*YesNoService Start Date* Date Format: MM slash DD slash YYYY Primary Applicant InfoName* First Middle Last Service Address* Street Address City State / Province / Region ZIP / Postal Code Service Address Type*Home OwnerRentingMailing Address* Same as Service Address Street Address City State / Province / Region ZIP / Postal Code Previous Address Street Address City State / Province / Region ZIP / Postal Code Email Address* Home Phone Number*Work Phone NumberMobile Phone NumberSocial Security Number*Social Security Number and Date of Birth required for online applications. If you do not wish to provide them, you can sign up in person at any of our offices.Birth Date* MM DD YYYY Drivers License / StateEmployerWould You Like to Add a Co-Applicant*If you do not add a Co-Applicant, you will be the only person who can make changes to your account. YesNoSpouse Or Co-ApplicantName First Middle Last Social Security Number*Social Security Number and Date of Birth required for online applications. If you do not wish to provide them, you can sign up in person at any of our offices.Birth Date MM DD YYYY Drivers License / StateEmployerHome Phone NumberWork Phone NumberMobile Phone NumberEmail Address Emergency Contact InfoSomeone Not Living With YouName* First Last Phone Number*Charity ProgramsParticipate in Round Up ProgramRead MoreYesNoTerms and ConditionsRead our terms and conditions, and privacy policy below.*Terms and Conditions Privacy Policy I have read and agree to the terms and conditions CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
