RESIDENTIAL APPLICATION FOR ELECTRIC SERVICE

1 Deposit Amount $_____(if applicable)Date Of APPLICATION _____Building Permit # _____(if applicable) Required for New MetersDate SERVICE is Required *_____RESIDENTIAL APPLICATION FOR ELECTRIC SERVICEThe ELECTRIC SERVICE requested for this purpose is for RESIDENTIAL NAME: (1) _____ADDITIONAL CUSTOMER: (2) _____SERVICE LOCATION: _____ House # (Lot #) Street Apt # City / Town ZipMAILING ADDRESS: _____(if different from above) House # (Lot #) Street Apt # City / Town ZipCUSTOMER PHONE: ( _____ ) _____ OTHER PHONE: ( _____ ) _____PLACE OF EMPLOYMENT _____ WORK PHONE: ( _____ ) _____Premises for ELECTRIC SERVICE is: Owned or Rented by Customer / Business Landlord s Name: _____SS #: (1) _____ SS #: (2) _____By signing and submitting this APPLICATION for SERVICE , the Customer ( Account Holder) agrees: PROMISE TO PAY.

2 To pay TMLP for any and all obligations for services provided including but not limited to all ELECTRIC SERVICE charges and any miscellaneous charges incurred within 25 days of invoice date. Security Deposits requests, back invoice charges, and reconnection charges must be paid immediately prior to SERVICE being restored. IDENTIFICATION: To provide proof of identification ( Photo ID) and passcodes to verify identity at any time by the TMLP regarding SERVICE requests. Additionally, Customer gives express authority to the TMLP to pull credit rating source verification reports through credit bureau agencies for any services provided by the TMLP.

3 SERVICE can be denied if no adequate assurance of payment is provided. COMMUNICATIONS: To authorize TMLP to communicate with Customer concerning any and all financial and non-financial aspects and details of my SERVICE and account via any means, whether written, or oral, via telephone, email, texting. TMLP agrees to not use such contact information for commercial advertising purposes. TMLP shall notify Customer via traditional means ( letter, telephone, voicemail) regarding any issues with account. Additionally, TMLP may utilize communications via electronic means ( email, texting, etc.) to relay important information regarding their account.

4 By establishing SERVICE , Customer agrees to accept any charges incurred from such electronic communications originated from the TMLP. If Customer does not wish the TMLP to contact via electronic means, then Customer must 'opt-out' of this communication method by initialing the box below or by going to our website at I opt out of receiving electronic communications ( email, texting, etc) originating from the TMLP to relay account information TMLP makes every effort to maintain privacy of all customer information as per the Company s adopted Red Flags policy which can be reviewed upon request or viewed at our website, (1) _____ _____ Date: _____ (Please print name of Customer) (Signature)(2) _____ _____ Date.

5 _____ (Please print name of Customer) (Signature)* In general circumstances, all new SERVICE requests are processed within three (3) business days once the SERVICE APPLICATION , building permit, wire inspection approval, and deposit are received by the OFFICE USE ONLYB usiness Partner #: _____ Contract Acct #: _____Account Determination ID in Contract Account (Choose one): RESIDENTIAL OtherConnection Object #: _____ Premise #: _____Utility Installation #1: _____ #2: _____ #3: _____Contract #1: _____ #2: _____ #3: _____Account Determination ID in Move-In (Choose One): RR RW RX RA RHTMLP Initials: _____ Date Completed: _____Comments: _____TMLP SERVICE APPLICATION FormLocal Information Temporary SERVICE Permanent ServiceService For: Resident Commercial Industrial MunicipalHot Water: ELECTRIC Oil Gas Wood Propane Other _____Air Conditioners: Qty/Units: _____ Tons/BTU: _____ Usage: _____Central Air: Qty/Units: _____ Tons/BTU: _____ Usage: _____Water Pump: Qty/Units: _____ Size/HP: _____ Usage: _____Pool.

6 Qty/Units: _____ Size/HP: _____ Usage: _____Electric Stove: Qty/Units: _____ Size/HP: _____ Usage: _____Electric Dryer: Qty/Units: _____ Size/HP: _____ Usage: _____Compressor: Qty/Units: _____ Size/HP: _____ Usage: _____Welder: Qty/Units: _____ Size/HP: _____ Usage: _____Primary Heat ELECTRIC Oil Gas Wood Propane Other _____Source:Primary Heat Baseboard Hot Water ELECTRIC Baseboard ELECTRIC Radiant Forced Hot AirType: Heat Lamp Heat Pump Steam Other _____Secondary Heat ELECTRIC Oil Gas Wood Propane Other _____Source:Secondary Heat Baseboard Hot Water ELECTRIC Baseboard ELECTRIC Radiant Forced Hot AirType: Heat Lamp Heat Pump Steam Other _____Service Information SERVICE Amps: 100 A 150A 200A 400A 600A 800A 1000A 2000A Other _____Service Volts.

7 120/208 120/240 480/277 Other _____Service Phase: 1 Phase 3 Phase SERVICE Location: Overhead UndergroundMeter Location: Outside House Inside House On Pole Other _____OFFICE USE ONLYRate Elec_01 Elec_02 Elec_05 Elec_11 Elec_21 Elec_31 Elec_35 Elec_37 Elec_39 Meter # _____ MRU _____ TMLP Initials _____ Date: _____Device Location _____ Device Location # _____Fees for Temporary SERVICE $ _____ Additional Fees $ _____Comments _____