Hardwick Electric Department
123 N Main St, PO Box 516
Hardwick VT 05843
Phone: 802-472-5201 Fax: 802-472-6769

Customer Application for Establishment of Electric Service

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Customer Information:
First Name:		   *
Last Name:   *
Social Security #:--  
Driver's License #:  *
License State:   *
Date of Birth:  *  

Billing Address:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Physical/911 address for service:
Service Address:   *
Town, State and Zip Code:   *
E-mail:  *
Confirm E-mail:  *
Phone:--   *
Cell Phone:--   *
Work Phone:--   
Joint Customer Information:
Name:		 
Social Security #:-- 
Driver's License #:  
License State:  
Date of Birth:    
Is this your main residence for at least 7 months a year?
(indicate yes or no)		  *

Online Access:
We offer a portal for online bill payment and account management. If you would like access to your account online, please create a password and password hint below. Please note passwords must be a combination of letters and numbers.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing/Previous Service:
Have you had service with us before?    
Account Number:
Customer Deposit or Credit Reference:
Credit reference can be from a bank or credit union with whom you hold a checking account stating that your account has been in good standing for the previous 12-month period

OR

Credit reference can be from another utility company stating that your account has been in good standing for the previous 12-month period.

OR

Customer deposit can be paid by cash, check, or credit/debit card.

Deposits are credited to your account after 12 months if you have not received more than three delinquent notices, or on the final bill if electric service is for less than 12 months. 

LANDLORD/AGENT VERIFICATION (Required if Renting)


Section Required If Tenant:
Owner Name:		  
Owner Address:  
Owner Phone:  
Section Required If New Owner:
Previous Owner Name:		  
Previous Owner Address:  
Previous Owner Phone:  
Do you rent or own the service location?
*If rent, Landlord is required to complete and submit LANDLORD/AGENT VERIFICATION to HED (link above)		   *
Please select preferred Billing Method:   *
 
I (we) hereby apply for electric service, to be furnished in accordance with the Hardwick Electric Department’s (HED) applicable rules and regulations as filed with and approved by the Vermont Public Service Board and are available for review at the HED office. I (we) agree to pay for such electric service in accordance with the department’s applicable rate schedules.

Notice

Pursuant to section 1704 of the charter of the Town of Hardwick and No.192 of the acts of 1898, charges for electric service are a lien upon real estate in the same manner to and the same effect as taxes are a lien upon real estate under 32 V.S.A. 5061. Property owners and tenants are advised that charges for electric service are lien upon real estate regardless of whether the property owner or the tenant pays for electric service.

Before charges for electric service are billed to a tenant, the property owner must complete a form authorizing the HED to bill the tenant for electric service.

HED requires two forms of identification. Copies of identification are required with this application.

This application and any additional documents required can be submitted in person or online:

Physical Address: 123 N. Main Street, Hardwick Vermont
Email Address: customerservice@hardwickelectric.com
Fax: 802.472.6769 
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Customer Name:     *