Hydro Reconnect Waiver

Mandatory fields are indicated with a red asterisk (*)

Name:

Account Number:

Address:

This is to confirm that I give my permission to Energy+ Inc. to reconnect the hydro service at the given address without me being present:

I confirm

I do not confirm

*Energy+ Inc. will not be liable for any damage to the Customer's premises resulting from such discontinuance of service.*

Name:

Signature:

Clear

Witness:

Date:

Form Builder