SNEW: South Norwalk Electric and Water > Forms > Application for Residential Electric Service

Application for Residential Electric Service

Printable Form, Residential Electric Service Application Form (PDF)

Date of Application:*
Date Format: MM slash DD slash YYYY
Date Service Requested:*
Date Format: MM slash DD slash YYYY
Former Tenant:*
Applicant Type*
- Tenant
- Owner
Check if Applicable:
- Electric Heat
- Electric Hot Water Heater
Applicant
Applicant Name*
First Middle Last
Service Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address(If different then Service Address)
Street Address Address Line 2 City State ZIP Code
Applicant's Contact Information
Home Phone*
Day time Phone (If different)
Email*
Applicant's Information
Date of Birth*
Date Format: MM slash DD slash YYYY
Drivers license no./state or passport no./country
Applicant's Place of Employment:
Office Telephone Number:
Fill out for Co Applicant
Applicant Name
First Middle Last
Mailing Address(If different then Service Address)
Street Address Address Line 2 City State ZIP Code
Co Applicant's Contact Information
Home Phone
Day time Phone (If different)
Email
Co Applicant's Information
Date of Birth
Date Format: MM slash DD slash YYYY
Drivers license no./state or passport no./country
Applicant's Place of Employment:
Office Telephone Number:
Please read this section carefully!
Applicants must provide a copy of their lease, closing statement or letter from owner. All individuals listed on the lease are required to sign the application form and are considered customers of SNEW.
All applicants must provide at least one of the following identification documents: Valid Drivers License, State of Connecticut Photo ID, Passport, Immigration and Naturalization Service Documentation or a Social Security Card with matching Official Photo ID.
The applicants for electric service agree to abide by and be governed by the rules, regulations, policies and practices of the South Norwalk Electric and Water currently enforce and as they are subsequently modified by the Second Taxing Commissioners.
In order to limit your liability, you, the consumer, will be responsible to notify South Norwalk Electric and Water in writing prior to termination of service.
Authorization*
- I/We the undersigned, hereby apply to South Norwalk Electric and Water for utility service at the above address and agree to be JOINTLY AND SEVERALLY LIABLE for payment for such service. (NOTE "Jointly and Severally Liable" means each applicant is personally and individually responsible for payment of the entire bill, and not merely their portion of the bill).
  I/We have read this application prior to signing it and understand its terms and conditions. I/We will follow all applicable rules and regulations.

Application for Residential Electric Service

Applicant

Applicant's Contact Information

Applicant's Information

Fill out for Co Applicant

Co Applicant's Contact Information

Co Applicant's Information

Please read this section carefully!