Service Request Form

This is a service request from for properties in Waterloo, Woolwich, or Wellesley. If your property is located in Kitchener or Wilmot, please complete the Service Request Form (Victoria Street Office).

Service Request Form – Engineering

Customer Information

Customer Name(Required)

Service Address – Customer(Required)

Address City/Township Postal Code (Enter N/A if not known)

Customer Primary Phone(Required)

Customer Secondary Phone

Customer Email Address

Electrical Contractor/Electrician Information

Company Name(Required)

Contact Name(Required)

Company Address(Required)

Address City/Township Postal Code

Business Phone Number(Required)

Email Address(Required)

Consultant Information

Consultant Details

This section is not applicable

Company Name(Required)

Contact Name(Required)

Consultant Address(Required)

Address City/Twp Postal Code

Business Phone Number(Required)

Email Address(Required)

Is this an Existing Service, or New Service?(Required)

Existing Service

New Service

Existing Service Details

(If applicable)

Existing Amperage(Required)

Existing Service Type(Required)

Existing Voltage(Required)

Existing Meter Details(Required)

Existing Meter Location(Required)

Desired Amperage(Required)

Desired Service Type(Required)

Desired Voltage(Required)

Scope of Work(Required)

New Service Details (Non-Existing)

Desired Amperage(Required)

Desired Service Type(Required)

Desired Voltage(Required)

For Multiple Service Addresses, Complete the Below

Unit/Lot

Municipal Number

Street

City/Twp

Amperage

Additional Information (if necessary)

Site Meeting Requested

Yes, I would like a site meeting

No, a site meeting is not necessary

Please add any additional details you believe are necessary

Please upload any photos or relevant files

Max. file size: 29 MB.

Email of Submitter(Required)

Date Submitted(Required)

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