Please complete this online form to request service from Diverse Power.

*required field

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Customer First Name:   *
Customer Last Name:   *
Customer Middle Initial:  
Social Security Number:(enter zeros if you wish not to provide)--  *
Driver's License #:  *
License State:  
Date of Birth:  *  
Employer:  
Employer Address:  

Enter the address where bills should be sent. Please do not abbreviate the name of the city:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Please enter the street address where service is required:
Service Address:   *
Meter Number:  
If applicable, directions to new construction:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--  
Work Phone:--   *
Spouse’s Name: 
Spouse’s SSN:(enter zeros if you wish not to provide)-- 
Spouse's Driver's License:  
Spouse's License State:  
Spouse's Birth Date:    
Spouse's Employer:  
Spouse’s Employer Address:  
Marital Status:  
Do you Own, Rent or Lease?  *

As one of our services, we provide an online application for viewing and paying bills. If you'd like to use this service, you can specify an Internet Password and Password Hint at this time. Please note that the Internet Password must be at least 4 characters in length.
Internet Password:  
Confirm Internet Password:  
Password Hint:

As a member of Diverse Power you will be enrolled in Operation RoundUp® unless you elect otherwise. Operation RoundUp® will round your bill up to the nearest dollar. For example, if your bill is $62.71, you will pay $63.00 with 29¢ going to the Diverse Power Foundation, a 501c (3) charitable organization. You'll contribute about $6 each year. These funds will benefit educational programs and community needs in the Diverse Power service area.

A credit check will be done to determine if deposits are required.

Membership Fee:  
Connection Fee:  

Enter an 'X' here if you do not wish to be included in Operation RoundUp.
 
Name of nearest relative not in your household:  
Relative's Address:  
Relative's Phone:  
Relationship:  
 
I have read, understood and agree to abide by the by-laws pertaining to membership of Diverse Power Incorporated. In addition, I also agree to the following:

1. I expressly consent to using or accepting electronic records or signatures relating to any transaction with Diverse Power and conducting transactions with Diverse Power electronically.
2. I agree to provide proof of my identity upon request of Diverse Power.
3. I warrant and represent that I own , control , or occupy : (a) the real , personal, and intangible property to or for which Diverse Power provides electric service at each location where service is provided and (b) the real property underlying or comprising each service location.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *