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 GENERAL SERVICES
Customer Information
Service Address
Account No.
Service (effective date)
Property Owner
Customer (Legal Business/Operating Name)
Licensed Vendor Number
Street No.
Street Name
Unit
City
Province
Postal Code
Home Phone
Work Phone
Cell
Identification (any 2 pieces, photocopy required)
Driver's License
SIN
Birth Certificate
Major Credit Card
In case of emergency re: electric service, contact:
Emergency Contact
Incorporated/Limited Coplease check
Franchised Businessplease check
Note: Address of Other Locations and Head Office (if applicable)
Address
City
Province
Postal Code
Type of Business
Officer/Partners (please include Full Name, Position, Address and Phone)
0 /
Previous Address
Previous Hydro Utility
SECURITY DEPOSIT and/or LETTER OF CREDIT REQUIRED
Deposit Amount $
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.
Owner/s Signature
Date
Owner Address (if Rental Property)
Tenant/s (if Consumer)
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