APPLICATION FOR ELECTRIC SERVICE
(Please print, fill out and send to Village Office)

In order that the municipality may keep aware of electrical demands the following information is required for all new requests for electrical service.

Electrician's Name: ___________________________________________

Address of Service: ___________________________________________

Location of Service: ___________________________________________

Size of Service: ___________________________________________

[ ] Single Family [ ] 2 Family [ ] Multiple Dwelling

Commercial: ________________ Type of Business:__________________

Industrial: _______________

Amount of Deposit (if applicable): _________________

Please check if the following are connected:
[ ] Electric Heat (Total Watts_______)
[ ] Electric Hot Water Heater (Total Watts_______)
[ ] Air Conditioning (Total Watts_______)
[ ] Electric Dryer (Total Watts______)
[ ] Electric Range & Oven (Total Watts______)
[ ] Dishwasher (Total Watts_______)

Note: Horsepower x 750 = kilowatts

Any other single load in excess of 2000 watts:_________________________

The Municipality is hereby requested to furnish the undersigned with electric service as indicated at the above address; such service is to be supplied by the Municipality in accordance with the rules and regulations as filed with the New York Power Authority and available for inspection at the office of the municipality will be paid for by the undersigned in accordance with applicable service classifications.

Applicant's Signature: ________________________________________

Date: ____________________

Application Received By: ________________________________________

Date: ____________________