Note: Please read overleaf before completing this form
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*
Preferred language*:
English
Spanish
Creole
Island*:
Providenciales
North Caicos
Middle Caicos
South Caicos
Grand Turk
Salt Cay
Metre number at location*:
Please indicate if:
Is there a Dusk to Dawn/Security light at this location?:
Yes
No
Should it be disconnected?:
Yes
No
Transfer Dusk to Dawn/Security light to another customer:
Yes
No
For special requests regarding your deposit:
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*:
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 credit to your local bank account. 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 applicable. 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.
Note: Tenants are required to notify FortisTCI upon termination of tenancy.
Fortis Tci
application & agreement for supply of electricity
