Moving Within Grimsby - Existing Customer

ACCOUNT NUMBER*

Moving From

Previous Address

Number*

STREET*

Unit

CITY

Province/Territory/State

Postal/ZIP code*

OCCUPANCY STATUS*

SERVICE END DATE*

Moving To

Service Address

Number*

STREET*

Unit

CITY*

Province/Territory/State*

Postal/ZIP code*

OCCUPANCY STATUS*

SERVICE START DATE*

Applicant

Surname*

First Name*

Middle Name

Mailing Address (If different from service)

Number*

STREET*

Unit

CITY*

Province/Territory/State*

Postal/ZIP code*

Home phone number*

Cell phone number

EMAIL*

Date of Birth*

Government Issued Identification*

ID Number*

Co-Applicant

If supplying a Co-Applicant, the fields marked * are required.

Surname*

First Name*

Middle Name

Home phone number*

Cell phone number

EMAIL*

DATE OF BIRTH*

Government Issued Identification*

ID NUMBER*

Payment Plan Options

1.Keep my existing Pre-Authorized Payment Plan and notify me if any changes are required.

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

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

4.None of the above.

NOTE: Choices 2 and 3 require a void cheque along with this application form. A void check can be uploaded below.

Pre-Authorized payments and Equal Monthly Payment/Pre-Authorized payments are deducted form your bank account upon due date of your bill.

Void Cheque

Acknowledgements

Terms and Conditions

I/We agree to accept Distribution Services from Grimsby Power Inc. in accordance with their Conditions of Service and be bound by them as they exist and are subject to change. Grimsby Power’s Conditions of Service may be viewed on our website at grimsbypower.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. Primary applicant listed above accepts financial responsibility for the account and can access all account information.

Payments to an account must be made in a timely manner, including security deposits. If payments cannot be made it is the customer’s responsibility to contact Grimsby Power. Service to a property can be disconnected for failing to pay your bill, security deposit or failing to follow through on payment arrangements. Grimsby Power will give advance written notice of disconnection that will contain the dates between which service can be disconnected and payment options.

I accept

Call before you dig!

If you are digging a hole deeper than 30 cm (12 inches) you require a locate to ensure there are no underground power lines. Accidently digging into one of these lines can be very dangerous and expensive. To request a locate, please contact Ontario One Call at 1-800-400-2255. Please call at least one week before you plan to dig.

Grimsby Power

Moving Within Grimsby

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Moving Within Grimsby - Existing Customer

Moving From

Moving To

Applicant

Co-Applicant

If supplying a Co-Applicant, the fields marked * are required.

Payment Plan Options

Owner Information

If tenant, the fields marked * are required.

Acknowledgements

Terms and Conditions

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