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 of this form if you are a Commerical or Industrial customer (additional information may be required).

Note: All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Account Holder Information:
First Name:		   *
Last Name:   *
*ID# and DOB are Required:
Social Security Number:		--  
NYS Driver's License Number:  
Date of Birth:  *  
Passport Number:  
Service Term:
Please indicate Long Term Purchase, Long Term Lease, Short Term Lease or Seasonal
*for long term a copy of lease is required to be emailed fmccustomerservice@fairportny.com		  *
Dwelling Type:
Please indicate Single, House, Apartment, Condo, Townhouse or Duplex		  *

Mailing Address:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Service Address:   *
City, State and Zip Code:   *
E-mail:  *
Confirm E-mail:  *
Phone #--   *
Cell Phone:--   *
Additional Contact:
Name:		  
Phone #:  
Former Address:
(if service is located within Fairport Electric and needs to be terminated please submit moving and final reading request form)		  *
City and State:  *
Zip Code:  *

Online Access:
We offer a portal and mobile app for ebill, online bill payment and account management. If you would like to access your account online, please create a password and password hint below. For security purposes, a maximum password length of 10 characters and a combination of uppercase letters, lowercase letters, numbers, and symbols (!@#$%^&*) is required.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Service History:
Have you ever had service with Fairport Electric?
    
Account Number:


Heat Source:
Please indicate Gas Heat, Electric Heat or Other		  *
 
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. I understand that Fairport Electric may bill me for the required Consumer Security Deposit.

*Email Address is used for E Bills and Notifications. Please check your spam/junk folder for your first bill.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Enter Full Legal Name Here:     *