Application For Membership

To establish electric service, complete the application below.  If you have any questions regarding new service please contact our office at (802) 472-5201.

Note: All fields with the asterisk (*) are required.


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:    
Employer:
*HED requires two forms of ID (license, passport, school id, birth certificate, etc)		  

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:    
Employer:  

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:
Deposit / Credit Reference Information:
A deposit or credit reference from your current utility or bank is required when you request service. Once your account has been officially created in our system you will receive a new account information email, including the total amount due as deposit on your new account.

RETURN OF DEPOSIT RULES:
1. MUST HAVE 12 CONSECUTIVE MONTHS WITH NO DISCONNECTIONS AND NO MORE THAN 3 DISCONNECT NOTICES.
2. DEPOSITS WILL BE APPLIED TO THE FINAL BILL, IF IT HAS NOT BEEN PREVIOUSLY REFUNDED OR APPLIED.
3. INTEREST IS ACCUMULATED EACH MONTH


Do you rent or own the service location?
*If rent, Landlord is required to complete and submit this form to HED		   *
Please select preferred Billing Method:   *
 
I (WE) HEREBY APPLY FOR ELECTRIC SERVICE, TO BE FURNISHED IN ACCORDANCE WITH THE HARDWICK ELECTRIC DEPARTMENT’S APPLICABLE RULES AND REGULATIONS AS FILED WITH AND APPROVED BY THE VERMONT PUBLIC SERVICE BOARD AND ARE AVAILABLE FOR REVIEW AT THE HARDWICK ELECTRIC DEPARTMENT 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 A 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 HARDWICK ELECTRIC DEPARTMENT TO BILL THE TENANT FOR ELECTRIC SERVICE.

PLEASE BE AWARE THAT ANY UNPAID BILLS LEFT BY A TENANT BECOMES A LIEN ON THE PROPERTY AS STATED IN OUR TOWN TARIFF.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Customer Name:     *