Residential Application For Service

Service Address:*
Street Address Address Line 2 City Postal Code
Mailing Address for New Service, if different than Service Address:
Street Address Address Line 2 City Postal Code
Lease / Ownership Start Date:*
YYYY slash MM slash DD
Please Select One:*
- Owner
- Tenant
Name of Property Owner:*
Owner Telephone Number:*
How many occupants are applying?*
- 1
- 2
- 3
Occupant 1:
Name:*
First Name: Last Name:
Date of Birth:*
YYYY slash MM slash DD
Driver’s License Number:*
Email:*
Home Telephone Number:*
Cell Phone/Other Number:
Previous Address:*
Employer Name:
Business Telephone Number:
Occupant 2:
Name:*
First Name: Last Name:
Date of Birth:*
YYYY slash MM slash DD
Social Insurance Number:
Driver’s License Number:*
Email:*
Home Telephone Number:*
Cell Phone/Other Number:
Previous Address:*
Employer Name:
Business Telephone Number:
Occupant 3:
Name:*
First Name: Last Name:
Date of Birth:*
YYYY slash MM slash DD
Social Insurance Number:
Driver’s License Number:*
Email:*
Home Telephone Number:*
Cell Phone/Other Number:
Previous Address:*
Employer Name:
Business Telephone Number:
Additional Contacts
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.
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 Check One:*
- TOU
- Tiered
I/we agree to: (1) pay the security deposit required; or (2) provide a one year electric utility credit history or (3) go on pre-authorized payments or (4) go on equal billing; 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 six equal installments, in six consecutive months commencing the month the service is put in my/our name where no credit history is available.

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 also understand that I/we may request a review of the account in one year to determine if I/we am/are eligible for a deposit refund.
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.
Consent:*
I agree.*
By providing my email address, Centre Wellington Hydro has my consent to contact me for important information via email.
Consent:
I agree.
As a tenant of the said property, I/we have read and understood that if the property is in a state of pending electric service disconnection Centre Wellington Hydro Ltd. may contact the owner of the property to notify them of the pending status.
Consent:*
I agree.*
CONSENT FORM FOR NEW CUSTOMERS

Centre Wellington Hydro Ltd. (CWH) is pleased to be your provider of electricity distribution services. In addition, CWH 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 CWH 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.
CWH 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, CWH 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 or regulation.

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 CWH Customer Service at 519-843-2900, or by email to enquiries@cwhydro.ca, or in writing to 730 Gartshore St., P.O. Box 217 Fergus, ON N1M2W8.
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.

Deposit refund policy available upon request.
Occupant 1 Name:*
Date:*
YYYY slash MM slash DD
Consent*
I agree.
Occupant 2 Name:*
Date:*
YYYY slash MM slash DD
Consent*
I agree.
Occupant 3 Name:*
Date:*
YYYY slash MM slash DD
Consent*
I agree.
Please accept this digital signature as my authority to activate this agreement.*
- Agree