Application for Service

Account Number:

Account Information:

Applicant: *
	* Owner Tenant Contractor
Service Address: *
Previous Address:
Mailing Address: *
Home Phone No:
Business No:
Cell No:
Fax:
Email Address:
Employer:
Driver’s License No:
S.I.N:
Date of Birth:	(DD/MM/YYYY)
Final Reading Date: (only if required)	(DD/MM/YYYY)

Name of Firm: *
Type of Business:
Doing Business As:
NAISC:	(Please refer to: http://www.statcan.ca/english/Subjects/Standard/naics/2002/naics02-menu.htm)
Type of Ownership *	Proprietorship Partnership Limited Subsidiary

If a subsidiary, please complete the following:
Legal Name of the Parent Company:
Name of Property Owner:
Owner’s Address:

Owner Information:

Lawyer’s Name:
Phone No:

Tenant Information:

Lease: *	Yes No
Expiry Date:	(DD/MM/YYYY)
Owner’s Name:
Phone No:
Address:

E-Bills:

Receive your hydro bill via email, and review your billing history online. Register now and your next hydro bill will be sent to the email address listed below.

Email Address:
Confirm Email:

Payment Plan Options:

A I/We wish to enroll in the Pre-Authorized Payment Plan.

* required

NOTE: Choice A requires a void cheque along with this application form.
Pre-Authorized payments are deducted from your bank account upon due date of your bill.

Security Arrangements:

Halton Hills Hydro required the payment of a security deposit from all customers who have not demonstrated a good payment history. Your security deposit will be on your first bill. To be exempt from this deposit, we require the following to be attached to or faxed with this application.

NOTE: Reference must be provided in the same name as the applicant listed on this application. Five to Seven (5 - 7) years of good payment history is required, some of which must have occurred in the past twenty-four (24) months.

Good payment history from a previous account with Halton Hills Hydro:

	Previous Account Number:
	Previous Service Address:

Reference Letter from another electricity or natural gas utility in Canada.
(Please fax refrence letter to (519) 853-2621.)

Equifax Credit Report showing good payment history.
Equifax: 1-800-465-7166 OR www.equifax.com
(Please include report with this application.)

Third Party Notification Authorization:

To protect your privacy our staff will not discuss details of your account with anyone other than those listed on your account. If you wish to designate a third party, who our staff can contact regarding your account for various reasons, you may give authorization below:

Contact:
Phone No:

Acknowledgement:

I/We agree to accept Distribution Services from Halton Hills Hydro in accordance with their Conditions of Service and be bound by them as they exist and are subject to change. Halton Hills Hydro’s Conditions of Service may be viewed on our website at www.haltonhillshydro.com. If you are a tenant, the owner’s name and address will be used to provide notice in the event your service is disconnected. The owner may also be notified of your final billing date. Customers listed above and have signed below accept financial responsibility for the account and can access all account information. Also, by signing the below noted you are accepting the Residential and Commercial Contract Terms.

Accept Terms *