Residential New Service Request
Please complete this form to apply for NEW service only.
If you are currently a GreyStone member and wish to transfer service to a new residence click here.
If you wish to disconnect your GreyStone service AND are not transfering service to a new residence please click here.
Please allow 3 business days processing time for all orders.
Please tell us about yourself:
*First Name:
*Last Name:
Middle Initial:
*Date of Birth:
*Social Security Number:
Check the box below if you do NOT have a driver's license.
No Driver's License
*Driver's License Number:
*State Issued:
*Expiration Date:
Check the box below if you are NOT employed.
Not Employed
*Employer:
*Employer Phone Number:
Authorized Person on Account Information:
*Relationship of Authorized Person:
Authorized Person's Name:
Authorized Person's Social Security No:
Authorized Person's Cell Phone:
Check the box below if the Authorized Person is NOT employed.
Authorized Person Not Employed
Employer:
Employer Phone Number:
Where do you currently live?
*Current Address:
Apt/Lot Number:
*Current City:
*Current State:
*Current Zip:
Who currently provides your Electric Service?
Check the box below if there is no current service provider.
No Current Provider
Present Power Supplier:
Power Supplier State:
Where is your new Electric Service?
*New Address:
Apt/Lot/Unit Number:
*New City:
*New Zip:
Please tell us about the New Residence
*Type of Heat:
Type of Heat (if Other):
Do you own or rent the New Residence?
*Own/Rent: Own  Rent  
If renting the New Residence, please provide Landlord information here:
Landlord Name:
Landlord Phone Number:
Landlord Address:
Landlord City:
Landlord State:
Landlord Zip:
Would you like Postpaid (regular) Billing or Prepaid Billing?
With Postpaid Billing you use power up front and pay for it later. GreyStone Power bills members monthly for usage and payment is due when rendered. Members using Postpaid Billing may be required to pay a deposit based upon credit history. The deposit is returned to members when they leave the system or after 18 consecutive months with on time payments.

Looking to take control of your energy usage and customize your payment schedule? A Prepaid account gives you the flexibility for when and how much you wish to pay - without deposits, late charges, disconnect or reconnect fees. Click here to read more about how our pay-as-you-go program can work for you!
*Type of Billing:
Do you wish to enroll in E-Bill?
If checked, your bill will be sent to the email address you provide below.
Enroll in E-Bill:
Where should we mail your bill (if different than the New Address)?
Mailing Address:
Apt Number:
City:
State:
Zip:
Contact Information:
*Primary Phone Number:
Secondary Phone Number:
Work Phone Number:
Fax Phone Number:
*Request Submitted By:    (Full Name)
*Email Address:
Enter the email address again for accuracy.
*Email Address:
*Daytime Telephone Number
(M-F between 8 AM & 5 PM):
Best time to call:
Relative Contact - Nearest Relative NOT Living in Household:
*Relative Name:
*Relation to Applicant:
*Relative Phone Number:
*Relative Address:
*Relative City:
*Relative State:
*Relative Zip:
When should service start?
*Service Start Date:    (MM/DD/YY)
NOTE: Fields marked * are required. Incomplete applications will not be processed.
The information provided will be used for the purpose of a credit check.

Completion of this form will not establish service if additional information is needed. A review will be conducted and any arrangements needed to collect the necessary deposit must be satisfied before this application for service can be completed and service connected. A valid contact name, e-mail address and phone number are required.



4040 Bankhead Highway 770-942-6576
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