RESIDENTIAL APPLICATION FOR ELECTRICAL SERVICE

IMPORTANT – COMPLETE AND RETURN FULL FORM

You must be 18 years or older to apply for service. Complete application must be returned. If this application is
incomplete, incorrect, or fraudulent, service will not be established. (*) Indicates a required field.

*Applicant First and Last Name: *Date of Birth: Social Security Number:
Nirav Savaiya 02/ 13 /1996 871570726
*Joint Applicants: (You must include all adult occupants listed on the mortgage, deed, or lease. Additional space on
back)
1. Date of Birth: Social Security Number:
/ /
2. Date of Birth: Social Security Number:
/ /
3. Date of Birth: Social Security Number:
/ /
*Service Address: *Primary Telephone Number:
331 Melwood Ave. 774-312-9005
Apartment/Floor/Unit/Suite: 4 Secondary Telephone Number:

*City: Pittsburgh *State: PA *Zip Code: 15213

Email Address: niravjwst@gmail.com  I authorize Duquesne Light to communicate with me via

email, including regarding this application (optional)
*Move In Date: 05/04/2019 *Turn On Date: 05/09/2019

Mailing Address (if different from Service Address):

*List all addresses where you lived in the last four years and dates you lived there.
*From: To: Address: 36 Lee St. Apt 1 City: Worcester State: Zip Code:
08 / 11 /2018 05 / 03 / 2019 MA 01602
From: To:
/ / / /
*If renting, provide name of Landlord: Lobos Management Telephone Number: 412-441-1400

Address of Landlord: P.O. Box 81067

If you are a landlord and this electric service will be used by your tenant, please check this box:

Please send 1) completed application and 2) copies of other documentation if requested by Duquesne Light (such as your
government-issued picture ID; or your mortgage, deed, or lease) to:

E-MAIL: applications@duqlight.com MAIL: Customer Service Applications Dept. 6-9

Duquesne Light Company
FAX: (412) 393-5881 411 Seventh Avenue
Pittsburgh, PA 15219

By submitting this application, you are hereby authorizing Duquesne Light to check credit history.

05/09/2019 _
*Signature Date *Signature Joint Applicant (if applicable) Date

Call Duquesne Light at (412) 393-7100 to pay your deposit or outstanding balance in certified funds (no personal checks).

RESAPP (04/19)
 RESIDENTIAL APPLICATION FOR ELECTRICAL SERVICE

*Additional Joint Applicants (include all adult occupants at service address listed on Social Security Number:
the mortgage, deed, or lease):

4.
5.

6.
7.
8.
9.
10.