RESIDENTIAL APPLICATION FOR SERVICE


The undersigned hereby applies to the Fairport Municipal Commission to supply electric service and agrees to abide by the rates, rules, and regulations adopted by the Municipal Commission. 

You must complete all fields. DO NOT submit more than one week before your closing date. 

Service Term:   
 Long-Term (e.g. Purchase)
 Long-Term (e.g. multi-year lease)  *Please attach a copy of Lease  Short-Term (e.g. One year or less Apartment Lease)         
 Seasonal      

Requested Service Date:

Service Located at:

City: State:  Zip Code: 

Dwelling Type (please choose from dropdown):  

Heat Source:    Gas Heat   Electric Heat     Other  

Billing Name:    

Former address (if service is located within Fairport Electric and needs to be terminated please submit a moving and final reading request form): 

Mailing Address (if different):

City: State: Zip: 
Date of Birth:              

Required ID #: 
*Please check one to indicate type of ID* 
 Social Security Number
 NYS Driver's License Number
 Passport
 Other (please specify) 


Phone #:       Cell #:  Cell Provider:  Check to receive Text Alerts

Email:
*Used for e-bills and notifications. Please check your spam/junk folder for your first bill.

  

Additional Contact (Phone # and Name): 


 I understand that Fairport Electric may bill me for the required Consumer Security Deposit


Security deposits are required for all short-term and seasonal customers. Security deposits are
equal to twice the estimated average monthly bill (see below). Security deposits are refunded after
twelve consecutive months of timely payments. We reserve the right to collect a security deposit
from any customer who makes a delinquent payment.

Type of Heat:
          House or Condo with Electric Heat - $350.00
          House or Condo with Non-Electric Heat - $110.00
          Apartment with Electric Heat - $185.00
          Apartment with Non-Electric Heat - $50.00

Signature(enter full legal name here): 

   
Make sure you check out our online payment portal to pay your bill online or setup autopay.