Commercial or Industrial Start Service Application

Section 1: Account Details

Commercial Account Name:

Service Address:

City:

Zip Code:

Is There a Different Mailing Address? Yes No

Mailing Address:

City:

Zip Code:

Phone Number:

Email Address:

Owner Name or Parent Company:

Corporation DBA Partnership LLC

Nature of Business:

SSN/EIN #:

State of Organization:

Does this business have or has it had service from Central Hudson or another gas or electric utility company? Yes No

Date of Last Service:

Utility Company:

Address of Last Service:

City:

Zip Code:

Section 2: 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:

Signer 2:

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:

Section 3: Connected 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:

Section 4: 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.

Section 5: Sign and Submit

Type Your Name to Sign:

Company:

Date:

Payments

Billing

Manage My Account

Save Money

Save Energy

Assistance Programs

Support

Forms

Working With Us

Outages

Storms

Safety

Commercial/Industrial Account Application

Section 1: Account Details

Section 2: Authorized Signers

Signer 1:

Signer 2:

Section 3: Connected Load Details

Single-Phase Electric:

Three-Phase Electric:

Gas Connected Load:

Section 4: Nonprofit Status

Section 5: Sign and Submit