Commercial Service Agreement

Application Date:*
MM slash DD slash YYYY
Please Select One:*
- Under 50KW
- Over 50KW
Business:
Name of Business:*
Legal Company Name:*
Type of Business:*
Service Address:*
Street Address City Postal Code
Mailing Address:*
Street Address City Province Postal Code
Business Telephone Number:*
Date Established:*
MM slash DD slash YYYY
Business Contact Name:*
Telephone Number:*
Mailing Address:*
Street Address Postal Code
Email:*

Please provide your email address & initial your consent.
Consent*
I agree
Date Service Required:*
MM slash DD slash YYYY
Please Check One:*
- Owner:
- Tenant:
Name of Property Owner:*
Owner Telephone Number:*
Customer Choice for RPP Customers
Under Time-of-Use pricing, the price you pay for electricity depends on when you use it. Under Tiered pricing, you can use a certain amount of electricity each month at a lower price and once that limit is exceeded a higher price applies. For Multi-Unit accounts a separate declaration form is required. For more information on Time-of-Use, Tiered Pricing and tools to help you decide which price structure is right for you, please visit www.oeb.ca/choice or www.cwhydro.ca. If no selection is made below the default is TOU.
Please Select One:*
- TOU
- Tiered
Sole Owner:
Sole Owner Name:
First Name Last Name
Date of Birth:
DD slash MM slash YYYY
Driver’s License Number:
Home Telephone Number:
Cell Phone/Other Number:
Partnership:
Partner Name:
First Name Last Name
Date of Birth:
DD slash MM slash YYYY
Driver’s License Number:
Home Telephone Number:
Cell Phone/Other Number:
Partnership Continued:
Partner Name:
First Name Last Name
Date of Birth:
DD slash MM slash YYYY
Social Insurance Number:
Driver’s License Number:
Home Telephone Number:
Cell Phone/Other Number:
Limited Company Officers or Subsidiary:
Name:
Title:
Name:
Title:
Parent Company:
Legal Name:
Location:
Telephone Number:
Additional Contacts:
Name:
Title:
Name:
Title:
I/We hereby apply to Centre Wellington Hydro Ltd. for electric AND water (if applicable) AND sewer (if applicable) service(s) at the service
address shown above. I/We agree to pay for such service(s) as bills are rendered and comply with the conditions for service of Centre
Wellington Hydro Ltd. and the Township of Centre Wellington.

I/we agree to: (1) pay the security deposit required; or (2) provide a 3 year electric utility credit history for service under 50kW or a 7 year
electric utility credit history for service over 50kW, in order to have this account transferred to my/our name. I/we understand that if my/our
credit rating or electric payment history is not acceptable, I/we am/are required to pay a security deposit. I/we understand that this deposit may
be paid in four equal installments, in four consecutive months commencing the month the service is put in my/our name. I/we further
understand that in the event of either non-payment of deposit or account, service may be terminated and not restored until payment is made in
full including a charge for collections and reconnection. I/we will also inform Centre Wellington Hydro Ltd. at least one week in advance of
when I/we plan to vacate the above premises.

As a tenant of the said property, I/we have read and understood that if the property is in a state of pending disconnection Centre
Wellington Hydro Ltd. may contact the owner of the property to notify them of the pending status.
Consent:*
I agree to the above terms.
Centre Wellington Hydro Ltd. will make every effort to ensure bills are accurate; however, billing errors can occur. Centre Wellington Hydro Ltd. reserves the right to collect under-billed amounts at any time.

I have read and understood the attached statement of Centre Wellington Hydro Ltd. regarding the collection, use and disclosure of my personal information, and I hereby consent to have Centre Wellington Hydro Ltd. collect and use my personal information for the purposes stated.

This information is collected in accordance with the Electricity Act, 1998 and related OEB Codes.
Name:*
Date*
YYYY slash MM slash DD
Consent*
I agree.
Name:
Date
YYYY slash MM slash DD
Consent
I agree.
Photo Identification Required:*
Please upload acceptable Photo ID, e.g., Drivers license, Passport or Provincial Identification Card.
Accepted file types: jpg, gif, png, Max. file size: 4 MB.
CONSENT FORM FOR NEW CUSTOMERS
Centre Wellington Hydro Ltd. is pleased to be your provider of electricity distribution services. In addition, Centre Wellington Hydro Ltd. provides water and sewer billing service to customers in the Township of Centre Wellington on behalf of the Township of Centre Wellington. As of January 1, 2004 the federal legislation protecting your privacy requires that Centre Wellington Hydro Ltd. obtain your written consent to collect, use and disclose your personal information for identified purposes. We invite you to read this notice carefully to understand our policies and practices with respect to personal information. The nature of personal information we collect may include:
- Information we receive from you such as your name, address, contact information and general financial, credit and reference information;
- Facts about your historical and current consumption of power;
- Information about your transactions with us, such as meter number, account number, account balances, payment history, and account activity;
- Identifying information, such as a driver’s license and social insurance number.
Centre Wellington Hydro Ltd. uses the information we collect for the following purposes:
- To provide you with continuous electric service and to bill you for that service;
- To assist us in the collection of accounts;
- As a billing and collecting agent for the Township of Centre Wellington for water and sewer service;
- To respond to your inquiries about energy use and billing;
- To prevent fraud with respect to both you, Centre Wellington Hydro Ltd. and the Township of Centre Wellington;
- To meet legal and regulatory requirements.
Because of the structure of the electricity sector in Ontario, it may be necessary to share your billing and consumption information with third party billing and settlement agencies. For example, your billing and consumption information may be provided to a retailer with whom you have chosen to enter into a separate contract. Your information may also be disclosed or shared with other agencies or organizations as required by law orregulation. We have developed and implemented a Corporate Privacy Policy for maintaining the confidentiality and security of your personal information. At any time, you have the right to request access to your personal information which we have collected and to request amendments to personal information about you to ensure its accuracy and completeness. To make a request for access to personal information we may have collected, disclosed or used about you or to request that your personal information be amended, please contact Centre Wellington Hydro, Customer Service at 519-843-2900, by email to enquiries@cwhydro.ca, or in writing to 730 Gartshore St., P.O. Box 217 Fergus, ON N1M 2W8.
Please accept this digital signature as my authority to activate this agreement.*
- Agree