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Move In / Move Out Form

Note: $250.00 Deposit and $30.00 Account Set Up fee will be charged to the first bill

Customer Information

Meter Number: Note: Meter number must start with "J", followed by 7 digits

Is this Meter Number on a reserve?

Yes No

Name of Customer Moving Out:

Date Previous Customer Moved Out

Name of Customer Moving In:

Date Customer is Moving In:

PO Box:

Community:

Postal Code:

Date of Birth:

Email:

Phone:

I want to receive bills through E-Billing:

Yes No

Account Number: (Optional) Note: Must start with "29" and be 12 digits in total

First Nation Band Name:

Certificate of Indian Status Card Number: Note: Must be 10 digits

Will the new account be a Band Account?

Yes No

What is the Program Responsible for this account?

Who is the Department Contact?

GST / HST Tax Exemption
I claim exemption from GST / HST under the following category:

Status Indian that is using electricity on a reserve. Indian owned sole proprietorship or partnership that is using electricity on a reserve. Indian Band Office / Band empowered schools, hospitals or Social Service entities that are using electricity on a reserve. Incorporated Band empowered entities for band management activities that are using electricity on a reserve.

Certification

To the best of my knowledge, the information contained in this form is accurate and complete.

Comments:

Note: $250.00 Deposit and $30.00 Account Set Up fee will be charged to the first bill

Customer Information

GST / HST Tax Exemption I claim exemption from GST / HST under the following category:

Certification

GST / HST Tax Exemption
I claim exemption from GST / HST under the following category: