Start Service / Escrow for Renters (Copy)

Name: Start Service / Escrow for Renters (Copy)
SKU: 2083
Price: 1.00 USD
Availability: InStock

$1.00

After you complete the Escrow transaction, you will be redirected to a $30 Administrative Fee that must be paid in order to process your request.

$

YOUR INFORMATION

First Name *

Middle Initial

Last Name *

Date of Birth *

Email *

Phone *

Service Address *

Is your billing address the same as your Service address? *

Yes

No

Billing Address *

This application is for the following service: *

Residential

Commercial

Will this be a joint account? *

No

Yes

Residential Property Type (Deposit Fee) *To make a deposit, select your property type. The fee is held in escrow and will be credited to your final bill when service is stopped.

Business Property Type (Deposit Fee) *To make a deposit, select your property type. The fee is held in escrow and will be credited to your final bill when service is stopped.

Previous Home Address *

Name of Previous Electric Company *

Are all residents of household 65 years of age or older? *

No

Yes

Is electricity operated life-support equipment to be used in this residence? *

No

Yes

Business Name *

Business Phone *

Previous Business Address

Name of Previous Electric Company

Co-Applicant First Name *

Middle Initial

Last Name *

Phone *

Email *

Which name do you want on your bill? *

Applicant Name

Co-Applicant Name

Both

LANDLORD INFORMATION

First Name *

Last Name *

Phone *

Email *

Address *

Apt/Suite

City *

State *

Zip *

START SERVICE CONFIRMATION

CONFIRMATION
By submitting this form, I confirm that this application has been prepared or examined by me. Under the pains and penalties or perjury, I declare that to the best of my knowledge and belief, it and all accompanying documents and statements are true, correct and complete.

Category: Escrow Charges

Start Service / Escrow for Renters (Copy)

YOUR INFORMATION

LANDLORD INFORMATION

START SERVICE CONFIRMATION

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MERRIMAC MUNICIPAL LIGHT DEPARTMENT