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Move Out - Notification Form

The Moving Out Notification Form (M1) is a document used to notify ND Energy Inc. that a customer is moving out and ending their utility account. It requires information such as the customer's name, address, contact details, forwarding address, account number, and planned move-out date. The form also has sections for landlords where they can agree to assume responsibility for utility services until a new tenant establishes an account. Signing the form acknowledges that personal information will be collected and used for billing purposes.

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38 views

Move Out - Notification Form

The Moving Out Notification Form (M1) is a document used to notify ND Energy Inc. that a customer is moving out and ending their utility account. It requires information such as the customer's name, address, contact details, forwarding address, account number, and planned move-out date. The form also has sections for landlords where they can agree to assume responsibility for utility services until a new tenant establishes an account. Signing the form acknowledges that personal information will be collected and used for billing purposes.

Uploaded by

promod
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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MOVING OUT NOTIFICATION FORM (M1)

Please complete and return this Moving Out Notification Form (M1) by mail, or
Email to [email protected] or via fax (905) 612-0259.

CUSTOMER INFORMATION (PLEASE PRINT)


Customer Status*: Account Number*:
All Fields With An Asterisk (*) Are Required Owner Tenant
Service Address*: (Street Number, Street Name, Unit Number) City*: Postal Code*: Electrical Vehicle Parking
Unit No. (if any)

Account Holder*: First Name*: Middle Name: Last Name*:

Forwarding Address for Final Bill*: (Street Number, Street Name, Unit Number) City*: Postal Code*:

Contact Information: Primary Phone*: Secondary Phone: Email*:

Name of landlord (legal owner of rental unit) *

Street Number* Street Name* Suite/Unit*

City * Province, country * Postal Code*

Home Phone* Cell Phone(optional)

Landlord Agreement

Landlords: By singing this agreement you agree to be the interim account holder for the services to Rental property.
You understand that whenever a tenant calls to close their ND Energy account, you will automatically assume
responsibility for the utility account and continued services starting on the tenant’s termination date and until such
time as a new tenant establishes an account with ND Energy. No reconnection or new account charges will apply to
you under this option.

This agreement is dates as of the Day of ,20

Landlord (Legal Owner) Signature Landlord (Legal Owner) Please Print

All information submitted through this process will only be used by ND Energy Inc. in support of our obligations
under the Utility Sub-Metering Agreement for each property. This information is being collected and used for billing,
collection, auditing and other necessary purposes, and will be assigned the appropriate confidentiality level on
receipt.
ND Energy Inc. | 6205A Airport Rd, Suite #301, Mississauga, ON L4V 1E1 | Tel. (905) 612-9879 | Fax. (905) 612-0259 | [email protected]
In accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA), the Resident named
above acknowledges that providing personal information to ND Energy Inc. is considered consent to collection, use
and disclosure for the stated purposes, and may only be shared with ND Energy Inc. and authorized third party
providers of ND Energy Inc.

*DATE OF CLOSING / LEASE END DATE (MOVE-OUT): / / (YYYY/MM/DD)


Company Name:
Seller’s Law Firm:
(If applicable)

(Street Number, Street Name, Unit Number)


Contact Information of Law
Firm:
City: Province: Postal Code:

Tel.: Fax.:

Email:

AUTHORIZATION: I understand that my security deposit, if applicable, will be applied to my account on final billing. Should the final billing
amount be less than the amount of the security deposit, ND Energy Inc. will mail a cheque for the balance to the forwarding address providing
above.

I confirm the information I have provided above is true and complete.

Account Holder Signature:

Date:
(YYYY/MM/DD)

By Mail: Send completed form to ND Energy Inc., 6205A Airport Rd, Suite #301, Mississauga, ON L4V 1E1.

ND Energy Inc. | 6205A Airport Rd, Suite #301, Mississauga, ON L4V 1E1 | Tel. (905) 612-9879 | Fax. (905) 612-0259 | [email protected]

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