Haldimand County Hydro - Online Moving Form

Online Moving Form

Fields marked with an asterisk * are required to be filled out.

Customer Contact Information
First Name*
Last Name*
Account #*	-
(if a current customer)	(i.e. 123456-12)
Phone #*
Email
I am a:*	Owner: Tenant:
Date of Birth*
Driver's License #:*
Emergency Contact Person:*
Emergency Contact Person's Phone #:*
Place of Employment:*
Employment Phone #:*


Move OUT Address (current/old service)
Street #*
Street Name*
City/Town*
Province / State*
Postal Code*
Telephone*
**Please exclude weekends and holidays.
Indicate Your* Move OUT Date

Are you the Owner or Tenant at this location?
	Owner: Tenant:

Move IN Address (future/new service)
Street #
Street Name
City/Town
Province / State
Postal / Zip Code
Telephone
**Please exclude weekends and holidays.
Indicate Your Move IN Date

Are you the Owner or Tenant at this location?
	Owner: Tenant:

Are you responsible for the utilities at the new address?* Yes: No:

Additional Comments



Please enter the security phrases above before submitting.

Call (905) 765-5211 if you would like assistance.