Move In / Within Territory - Westario Power Inc.

Service Request Information

Name of Applicant(s)*

Service Address*

Street Address Address Line 2 City Province Postal Code

Mailing Address (if different from Service Address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Service Commences*

Do you currently have a Westario Power account?*

Previous Account Number(s)*

Do you require a final meter read at this address?*

Please enter the date required for final meter read*

Ownership Status

Will you be renting or owning the Service Address*

Landlord's Name*

First Last

Lawyer's Name*

Phone*

Applicant Information

Name*

First Last

Date of Birth*

Phone*

Secondary Phone

Email*

Driver's License*

Security Question #1 - Mother's Maiden Name*

Security Question #2 - Best Friends Name*

Employer's Name*

Phone*

Applicant Information

Name

First Last

Date of Birth

Phone

Secondary Phone

Email

Driver's License

Security Question #1 - Mother's Maiden Name

Security Question #2 - Best Friends Name

Employer's Name

Phone

Pre-Authorized Payment

Name of Financial Institution

Transit Number (5 digits)

Institution Number (3 digits)

Account Number

E-Billing

Register for E-Billing*

Security Deposit

Security Deposit requirement. (Please submit your Letter of Reference with this application if available) All customers opening a new account with Westario Power are required to pay a security deposit, except where the customer provides a letter of reference from a gas or electricity distributor in Canada confirming “Good Payment History”. Residential customers shall be permitted to pay deposits in equal instalments up to a six-month period.

Number of Required Instalments*

Additional Comments

Agreement*

I have read and understood Westario Power's Conditions of Service in its entirety By clicking on the "I accept" button following this statement you: (1) certify that the given information is true, correct and complete to the best of my knowledge; (2) Irrevocably accept to enter into a valid and legally binding agreement with Westario Power in accordance with the terms of Westario Power's Conditions of Service. Submission of fraudulent information will result in electrical service being disconnected.

I Agree

Date

Service Request Information

Ownership Status

Applicant Information

Applicant Information

Pre-Authorized Payment

E-Billing

Security Deposit

Service Contacts