Current Service Address Information Secondary Customer Information (Optional) Security Deposit Privacy of Information Pre-Authorized Payments Form Complete Service Address Service Address Enter the service address in which you are moving into. Unit #/P.O. Box City/Town State/Province - Select ---- Canada Provinces ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon--- US Provinces ---AlabamaAlaskaAmerican SamoaArizona ArkansasArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)CaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Country - None -CanadaUnited States Customer Identification I am the owner of the service address. I am the tenant of the service address. Landlord Name Effective Date Primary Customer Name Business Name Primary Customer Information Business Principals First Name Business Principals Last Name Driver’s License The Service Address is the same as my Mailing Address. Mailing Address Mailing Address Unit #/P.O. Box City/Town State/Province - None ---- Canada Provinces ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon--- US Provinces ---AlabamaAlaskaAmerican SamoaArizona ArkansasArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)CaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Country - None -CanadaUnited States Phone Number E-Mail Address Business President or Owner Business President or Owner First Name Business President or Owner Last Name Date of Birth If you would like to opt out of e-billing immediately, please check this box. Business Description Business Number General Service Classification All non-residential Customers who hit 50kW or greater in any month of the year are to be classified as General Service above 50kW. For new Customers without prior billing history, or existing customers after service size modification, the demand peak will be based on 80% of the service entrance capacity. I hereby request E.L.K. Energy Inc. to supply electrical service to the premises at the above address. I hereby further agree to pay for service at the authorized rates from the date on which the service is connected, subject to change from time to time. Statements are payable on or before the due date. All accounts not paid by the due date are subject to a late payment charge, as well as collection action including disconnection and payment of a reconnection fee. I understand that in the event that this electrical service requires connection that the connection will only occur during regular business hours. No gurantee of connection date will be made, all connections will be made on a best effort basis. I acknowledge and understand that a copy of E.L.K. Energy's Conditions of Service is accessible for my review at the customer service counter at the office as well as on the website. To switch from Time-of-Use to Tiered Prices, you must notify E.L.K. Energy Inc by completing an election form found on our website.
