Electric Service Request - PropOwner,Realtor,PropManage,Foreclosure

Service address*

Street Address

Unit/Suite

CityState

Zip Code
If multi-unit building, please provide meter serial number
Do you wish to begin or end service at the property?*

Begin serviceEnd serviceRestore service
Effective date you took possession of property*

MonthDayYear
Date
Business name
OR
Personal name

First NameLast Name
Federal tax ID*
Complete W-9 form and upload it below.
Upload completed W-9 form

Cancelof
Social security number*
Billing address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary phone number*
Contact email address*
example@example.com
Please check*

Property ownerRealtorProperty managerThis is a foreclosed property
Do you want to be set-up as the default landlord?*

YesNo
Is your business exempt from sales tax on electricity purchases?*

YesNo
If yes, complete and return ST3 form, indicating percentage exemption.
Upload completed ST3 form

Cancelof
Please tell us why you are ending service*

I am no longer the Property Manager/RealtorThe property has been sold.
Closing date*

MonthDayYear
Date
New owner name

First NameLast Name
New owner phone number
Please enter a valid phone number.
NOTE: new party is responsible for calling Connexus Energy for new service.
Please indicate date to restore service. NOTE: Connexus needs to be notified at least two business days prior to restoration date. I understand there is a reconnect fee.*

MonthDayYear
Date
Signature*

Clear
Date

MonthDayYear
Date
Please verify that you are human*
By providing your phone number(s), including any mobile number, you authorize Connexus Energy and its agents to contact you regarding your account using any means, including automatic telephone dialing systems, prerecorded voice messages, text messages, or other forms of communication. You understand that message and data rates may apply. Your consent is not a condition of receiving service. If your number changes, you agree to promptly notify Connexus Energy.
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