200-395 Centre St North, Huntsville, ON P1H 2M2 | Fax (705) 789-3110
Tel (705) 789-5442 or 1-888-282-7711 | Email service@lakelandpower.on.ca

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APPLICATION FOR RESIDENTIAL HYDRO SERVICE
Customer Information
Service (effective date)
First Name
Last Name
Initial
Street No.
Street Name
Unit
City
Province
Postal Code
Date of Birth
Home Phone
Work Phone
Cell
Name of Spouse (to be listed on account)your full name
Mailing Address (if different from above)
Street No.
Street Name
Unit
City
Province
Postal Code
Property Information
Are you the property owner?
Are you the tenant?(if yes, enter property owner info below)
Owner (full name)
Phone
Credit Information & Identification
Name of Employer
Address
If unemployedplease check
Name of Worker
Phone
Identification (any 2 pieces, photocopy required)
SIN
Driver's License
Birth Certificate
Major Credit Card
Previous Address
Street No.
Street Name
Unit
City
Previous Hydro Utility
Name of Bank
Branch Location
* A security deposit is required unless customer is enrolled in the Pre-Authorized Payment Plan (PAP). Credit reference from a previous utility is required for PAP.
Deposit Amount $
OR
After your 1st bill has been processed and sent to you, you will be enrolled in paperless E-Billing for all future bills. E-Bill notifications will be sent monthly to the email address filled out above. Please indicate here if a different email address is preferred
Initialyour full name
I have read and understood the statement (see reverse) of Lakeland Power regarding the contractual obligations, collection, use and disclosure of my personal information, and I hereby consent to have Lakeland Power collect and use my personal information for the purposes as stated.
Applicant Signature
Date
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