Service Request Form  

Please Note:
Fields marked with an * are required. 
For general requirements:
View our Conditions of Service

Download the PDF version of the application form.

 Customer Information 
Name: *
Unit/Lot #:  
Civic #: *
Street Name: *
City/Twp: *
Postal Code:  
Primary Phone: * ( )  
Secondary Phone: ( )    
Cell Phone: ( )    
Fax / Email:


 Electrical Contractor / Electrician Information 
Company Name: *
Contact Name: *
Address:
City/Twp:
Postal Code:  
Business/Cell Phone: * ( )   ext.  
Fax / Email: *

 Consultant Information 
Company Name:
Contact Name:
Address:
City/Twp:
Postal Code:  
Business/Cell Phone: ( )   ext.  
Fax / Email:

EXISTING SERVICE DETAILS  
Existing Amperage: *  
Existing Meter Details: *   
Desired Amperage: *  
Scope of Work:

 

  NEW SERVICE DETAILS (Non-Existing) 
Desired Amperage: *   

 

  For multiple service addresses, complete below:  
Unit / Lot: Civic:  Street:  City/Twp:  Amp: 
Unit / Lot: Civic:  Street:  City/Twp:  Amp: 
Unit / Lot: Civic:  Street:  City/Twp:  Amp: 

 

ADDITIONAL INFORMATION
 
If you would like to attach a file to the application please click the Browse... button below and select the file.
Note: Allowable filetypes are: DOC, PDF, JPG, GIF, TIFF, PNG, BMP, or DWG; The maximum file size is 10MB.
Attach File:  
Applicant: *
Applicant email:
  If you require a copy of the submitted applicaiton, please supply your email address to receive a copy.
 









Engineering Department
526 Country Squire Rd, Waterloo Ontario N2J 4G8     ECRA/ESA Licence # 7004206
Telephone: 519-888-5552     Fax: 519-886-7049     E-mail: eclerk@wnhydro.com