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590 Steven Court, Newmarket, Ontario L3Y 6Z2 ? Tel: 905-895-2309 ? Fax: 905-895-8931 ? Email: email@example.com RESIDENTIAL DISTRIBUTION SERVICES AGREEMENT Please complete and return within 10 business days Account No.: Effective Date: Part 2 - To Be Completed By Tenants Owner’s Name:__________________________________________________________________________ Address:________________________________________________________________________________ (No.) (Street) (City/Town) Part 3 – To Be Completed By Existing and Former Customers Previous Service Address:__________________________________________________________________ (No.) (Street) Part 1 – To Be Completed by All Applicants Date:____________________ Mr. Mrs.___________________________________________________________________________________ Ms. (Last) (First) (Initial) Service Address:______________________________________________ Postal Code:______________ (No.) (Street) Apt. No.:__________ Owner: _____ Tenant:_____ Phone: (_____) __________________ (_____) ________________ (Residence) (Business) Employer:_______________________________________________________________________________ I would like my bills sent to the above address ____ OR: Mailing Address:_____________________________________________________ Apt/Unit No.:_________ (No.) (Street) City/Town:___________________________________________________ Postal Code:_______________ Applicant’s Spouse or Co-occupant:________________________________ Phone:(_____) _____________ (Last Name) (Firstl) Part 4 – Applicant’s Acknowledgement I agree to accept Distribution Services from Newmarket Hydro in accordance with its Conditions of Service and be bound by them as they exist and may be amended from time to time. I also agree to the terms and conditions of billings for municipal water and wastewater services established by the Town of Newmarket. Signature:________________________________ Co-Applicant:___________________________________ Newmarket Hydro Conditions of Service are available for review at our offices at 590 Steven Court, on our web site at www.nmhydro.on.ca or in hard copy at a cost of $172.49 plus applicable taxes.