Request for Service Connection Please complete the form below and provide as much information as possible.Please note, all inquiries will be responded to within 2 business days. Electrician's Name:* First Last Electrician's Telephone #:*Customer / Builder's Name:* First Last Customer / Builder's Phone #:*Service Address:* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Lot and Concession #:Service Type Commercial Residential New Line TypeOverheadUndergroundUnknownService Voltage120/240120/208347/60027.6/16/2480/277UnknownNew Service Type:60A100A200A400A600AUnknownMeter Location on Building Left Hand Side Right Hand Side Responsible Party to Pay Cost Incurred:BuilderElectricianOwnerOtherIf you answered Other, please explain:Electrical Billing to be setup for:Full Name First Last Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Telephone #:Would you like a copy of this form emailed to you? No Yes Which email should we send it to?* Disclaimer Personal information provided to Bluewater Power is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be stored, used and disclosed in accordance with that legislation. Do you acknowledge the disclaimer above?* Yes, I do.