Non Residential - PSEG Long Island

Current Balance

Due on MM/DD/YYYY

Current Balance

Due on MM/DD/YYYY

Start New Non-Residential Service

Please complete all fields.

* First Name

* Last Name

* Business Phone Number

* Mobile Phone Number

Social Security Number

Invalid SSN No.

* Tax Status Non Tax Exempt Tax Exempt

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or Remove Attachment

Supporting documentation is required

Link to existing summary account number

* Please list the name and phone number for all Principal Officers of your business.

At least one row in the principal officers section needs to be filled in.

PLEASE NOTE: All fields marked with an asterisk (*) are required.

Account and Property Information

Please complete all fields.

* Have you had or do you currently have a non-residential account? Yes No

* Existing Account Name

* Existing Account Number Invalid Account No

* Existing Account Address

Existing Account Address Line 2

* Existing Account City

* Existing Account ZIP Code

* If this is an active account, do you want the service shut off? Yes No

* Date to Stop Existing Service

Date field is required

February 2011

SUN	MON	TUE	WED	THU	FRI	SAT
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* Date to Start Service

Date field is required

February 2011

SUN	MON	TUE	WED	THU	FRI	SAT
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Go to previous month

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* New Service Street Address

New Service Address Line 2

* New Service City

New Service State

* New Service ZIP Code

* Is your mailing address the same as the service address? Yes No

* Mailing Address

Mailing Address Line 2

* Mailing Address City

* Mailing Address State

* Mailing Address ZIP Code

* Do you own or rent? Own Rent / Lease

Photo Identification

* Please upload a copy of your government issued photo identification. If you do not wish to upload identification, please download the application here and have it notarized. * Please upload 2 forms of identification. One ID must be your government issued photo identification. If you do not wish to upload identification, please download the application here and have it notarized.

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Supporting documentation is required

* Please upload your Lease or Deed. Note: Your Date to Start Service must match the date on your Lease or Deed.

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or Remove Attachment

Supporting documentation is required

PLEASE NOTE: All fields marked with an asterisk (*) are required.

Meter Access Information

Meter Access Information In order to provide bills based on actual readings, we must have access to your meter. When access cannot be obtained for a specified period, you or the person controlling access to the meter will be subject to non-access charges and possible termination of service as specified in the tariff

* Do you control access to your electric meter? Yes No

* Landlord Name

* Landlord Address

* Landlord Address City

* Landlord Address State

* Landlord Address ZIP Code

* Who controls access to your meter?

Service and Rate Classification

It is important to answer the following questions accurately. PSEG Long Island will help you choose the service classification which is most appropriate for your current needs, based on the information you provide. There are eligibility requirements for each service classification and you may qualify for more than one and one service classification may be more beneficial than another. The cost of electric service may vary depending on the service classification. In classifying your service, we may rely on the information that you provide us. If service information you provide is inaccurate or incomplete, you may be subject to back billing or may be precluded from receiving a refund for overcharges from the resulting incorrect billing. If your use of service or equipment changes in the future, you must notify PSEG Long Island, so that you may be properly billed. Questions about service classification may be discussed with our customer representatives. The tariff for electric service describes each service classification in detail can be found here https://www.lipower.org/about-us/tariff/

** NOTE: Religious institutions, veterans organizations and qualified community residences may choose service under an appropriate residential or non-residential service classification, subject to a minimum term of one year. Proper supporting documentation must be submitted with this application

All corporations, including those out of state, must fie with NYS in order to operate within. Corporations are subject to verification entity status in the NYS Corporation and Business Entity database. http://www.dos.ny.gov/corps/bus_entity_search.html

PLEASE NOTE: All fields marked with an asterisk (*) are required.

General Service Classification Information

* Will the same electric equipment as the prior customer be used? Yes No

* Do you have permanently installed electric space heating? Yes No

* Is there any significant change in use from the previous customer? Yes No

Load Information * Provide the following Estimated Monthly Connected Demand (kw/Month)

Lights

Motors

Common Area Load

Air Conditioning

Miscellaneous

Electric Heating

Please enter values for selected checked.

* Provide the following Estimated Monthly Demand Less than 7 KW Over 145 KW (June-Sept) or 500 KW (Oct-May) 7 KW Or More Unknown

* What is the size of your premises?

* Upload your electric load letter

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Supporting documentation is required

As a new customer, you are required to provide a monetary deposit when applying for service. The deposit will not exceed twice the average monthly usage during your peak season. Interest is paid on all deposits. You may request that your account be reviewed to assure that the deposit is not excessive. Deposit alternatives that provide a level of security equivalent to cash, such as irrevocable bank letters of credit and surety bonds, may be accepted. The value of the required deposit will be provided via email once PSEG Long Island reviews your application for service.

* Service Initiation Charge

Turn on, New Set, Pole cut - $220.00 Change name - $60 Seasonal - $80 reconnect fee for returning seasonal customers Landlord-Change Name-Vacant - N/A

Note: For Landlord Change Name - Vacant, charge will not be applied to an account transferred to a landlord for the vacant time period between tenant occupancy if power has not been disconnected.

Commitment/Signature/Certification of Application

* Application submitted by: (please select one) I have obtained the permission of the owner to install electric service facilities and further, that said owner is aware that PSEG Long Island is not responsible for permanent restoration on private property. I am the owner of the real property onto which proposed service facilities shall be installed and further, I am aware PSEG Long Island is not responsible for permanent restoration on private property. Service is requested through existing facilities.

I/We agree to pay for service supplied to the premises applied for in this application at the rates, charges and terms in accordance with the provisions of the tariff for electric service, and any applicable laws, regulation or ordinance. To the best of my/our knowledge, the information provided here is accurate and no attempt has been made to misrepresent the facts

By checking this box you are indicating that you are the owner, officer or authorized agent.

Start New Non-Residential Service

About You

Please enter a valid Account Number or Customer ID

Principal Officers

Account and Property Information

Photo Identification

Lease or Deed

Meter Access Information

Service and Rate Classification

Enter the values For Multi Family with Apartment

General Service Classification Information

Please enter values for selected checked.

Deposit Information

* Service Initiation Charge

Commitment/Signature/Certification of Application

This Field is Required.

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Start New Non-Residential Service

About You

Please enter a valid Account Number or Customer ID

Principal Officers

Account and Property Information

Photo Identification

Lease or Deed

Meter Access Information

Service and Rate Classification

Enter the values For Multi Family with Apartment

General Service Classification Information

Please enter values for selected checked.

Deposit Information

* Service Initiation Charge

Commitment/Signature/Certification of Application

This Field is Required.

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