Service Termination and Closure

* Denotes Required Inputs

Service Termination And Closure Of Account Form

Note: Please read overleaf before completing this form

hereby authorize and direct FortisTCI to

Disconnect my electrical service at the address below and connect my service at another location*:

Disconnect my electrical service at the address below and close my account.*:

Effective date*:

Reason for termination of service:

Customer Name*:

Customer Account No.*:

Service Address*:

Metre number at location*:

Contact numbers:

Email address:

New (forwarding) address (if any):

Name of Employer*:

Employer’s address*:

Employer’s Phone*:

Please indicate if: Is there a DD light at this location?: Yes No

Should it be disconnected?: Yes No

Transfer DD light to another customer: Yes No

Please provide customer’s Account* #:

For special requests regarding your deposit:

Deposit credit refund amount to*:

Bank Account:

Transfer deposit to:

of UT account No.*:

Temporarily hold deposit*:

Note: The name on the bank account must match the name on file for the FTCI account

Upload Photo ID:

I, the undersigned hereby release , indemnify and hold FortisTCI harmless form and against any and all claims, losses, costs and liabilities arising in any way from the execution of the above instructions.

Customer Name And Signature/date*:

Customer Service Representative’s Name & Date:

Please note the following:

The Security Deposit is automatically applied to any outstanding balance owing, as well as the final billing amount on this account.
Any remaining credit will be applied to any historical account balance/s owed by you to FortisTCI.
If you do not have any overdue balances, the remainder of the deposit will be refunded to you by cheque payment. Please note that we do not issue refunds in any name other than the customer who has the agreement with FTCI
A photo ID must be provided when submitting this form.
Where there are two individual names on an account, either individual can request termination of service.
A photo ID must be presented when collecting a deposit refund cheque. If you are acting on behalf of another customer, a written authorization along with that customer’s photo ID must be provided.
All balances MUST be made current upon submission of a closure of account request. If this is not feasible, a payment schedule MUST be set up with the Credit Control Department.