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Service Layout Application Form

Notice of Collection

Personal information is collected on this form by GrandBridge Energy under the authority of the Electricity Act, S.O. 1998, Chapter 15, Schedule A. The principal purpose for the information we are collecting is to accurately deliver our services to you, Engineering Services, and ensuring that we are dealing with only you or individuals you have authorized. Personal information will be used only for the purposes set out in GrandBridge Energy's Privacy Policy. Learn more www.energyplus.ca/privacypolicy

If you have any questions about this collection process, the ways in which your personal information may be used by GrandBridge Energy, or would like further information about GrandBridge Energy’s privacy policies, please contact: GrandBridge Energy’s Chief Privacy Officer, 1500 Bishop Street, Cambridge, ON by phone 519-621-3530, or by e-mail at: privacy@grandbridgeenergy.com.

Date:

Service Address (please include unit # if applicable):

Customer Account Number (if applicable):

Customer's Name:

Customer's Phone Number:

Customer's Email:

Electrical Company:

Electrician's Name:

Electrician or Company's Phone Number:

Email:

Scope of Work:

Existing Service Type:

Proposed Service Type:

Phase Type:

Existing Service Voltage:

Proposed Service Voltage:

Existing Service Amps:

Proposed Service Amps:

Drawing or additional documents of proposed work (if applicable):

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Additional Comments:

Signature:

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Service Layout Application Form

Notice of Collection