Commercial or Industrial Start Service Application

1. Account Details

Legal Entity Name (use personal name when necessary):

DBA (if applicable):

Entity Type: Corporation Partnership LLC Sole Proprietorship

Owner Name or Parent Company:

Nature of Business:

State of Organization:

SSN:

New Service Address:

City:

Zip Code:

Is There a Different Mailing Address? Yes No

Phone Number:

Email Address:

2. Present or Previous Service Information

Has the business ever received utility services? Yes, from Central Hudson Yes, but from another company No

3. Authorized Signers

Signer 1:

Name:

Title:

Address:

City / Town:

Zip Code:

Phone Number:

Social Security Number:

Driver's License Number:

Driver's License State:

Expiration Date:

Type Your Name to Sign:

Add a second signer? Yes No

4. Load Details

Single-Phase Electric:

Number of Motors:

Motors Horsepower:

Lighting (KW)

Heating (KW):

Number of Air Conditioning Units:

Air Conditioning (KW):

Refrigeration (KW):

Other Load Type:

Other Load Type (KW):

Three-Phase Electric:

Number of Motors:

Motors Horsepower:

Lighting (KW):

Heating (KW):

Number of Air Conditioning Units:

Air Conditioning (KW):

Refrigeration (KW):

Other Load Type:

Other Load Type (KW):

Gas Connected Load:

Heating (BTU):

All Other Appliances (BTU):

Access Controller Name:

Phone Number:

Address:

City / Town:

Zip Code:

5. Nonprofit Status

Public Service Law Section 76 permits any corporation or association organized and conducted in good faith for religious purposes, certain community residences and veterans' organizations to receive service at rates no greater than the rates charged to residential customers. If you meet one of the following criteria, please check the applicable box: Location is a post or hall owned or leased by a nonprofit corporation that is a veterans' organization Location will be used as a community residence occupied as a supervised or supportive living facility as defined by Mental Hygiene Law, Section 1.03, subdivisions 28a and 28b; the location will provide living accomodations for 14 or fewer residents and will be operated by a nonprofit organization. Not applicable Location will be used solely for religious purposes by the religious organization applying for service.

6. Sign & Submit

Type Your Name to Sign:

Company:

Date:

Commercial/Industrial Account Application

1. Account Details

2. Present or Previous Service Information

3. Authorized Signers

Signer 1:

Signer 2:

4. Load Details

Single-Phase Electric:

Three-Phase Electric:

Gas Connected Load:

5. Nonprofit Status

6. Sign & Submit

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Commercial/Industrial Account Application

1. Account Details

2. Present or Previous Service Information

3. Authorized Signers

Signer 1:

Signer 2:

4. Load Details

Single-Phase Electric:

Three-Phase Electric:

Gas Connected Load:

5. Nonprofit Status

6. Sign & Submit