Customer Intake Form
Haliburton Electric
Name
First Name
Last Name
Email
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your expected timeframe for electrical work to start?
Location of Work Site
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Accessible by Road?
Driving Directions
Additional Details ( eg. need to coordinate to arrange access to site)
Contractors Information
First & Last Name
Email
Phone Number
Business Name
Work Details
Brief description of electrical service:
Description of Building/Site
Residential ( Year-Round)
Residential ( Seasonal)
Business/Commercial
Camp
Farm
Industrial
Other
If other, please specify:
Type of Electrical Services
Overhead
Underground
Central Metering
Unmetered/Off Grid
If Existing, what type
Cutler-Hammer
Eaton
FPE/Stablok
Fuses
Homeline/Schneider
Leviton
Seimens
Square D
Unknown at this time
Other
If other, please specify:
Photos of Service/Panel (if Existing)
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Size of Service (Amps)
Has a Hydro Layout been requested?
Yes
No (Please go to hydro One website have one completed (if necessary): www.hydroone.com/business-services/builders-and-contractors/newservice-layout)
If Yes, please upload Hydro Layout here:
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Building Information
Size of Building (Square Feeet)
Garage
Yes
No
Unknown at this time
Outbuilding On-Site
Yes
No
Unknown at this time
If yes, how many outbuildings? Are they heated?
Heat Sources, Select all that apply
Furnace (Electric)
Furnace (Propane)
Heat Pump
Radiant Heat Boiler (Electric)
Radiant Heat Boiler (Propane)
In-Floor Electric Heat Cables
Electric Heat (Baseboard or Fan Heaters)
Wood Fireplace
Propane Fireplace
Other
If Other, please specify:
Air Conditioning:
Yes
No
Unknown at this time
Water System, Select all that apply:
Well Pump
Lake Pump
City/Town Water
Sewer System, Select One
City/Town Sewers
Septic Bed
Unknown
If septic bed, any septic pumps?
Kitchen Appliances:
Please upload any documents you have for kitchen appliances or other electrical specifications:
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Propane Tanks Located On-Site
Yes
No
Hot Tub
Yes (wood-Fired)
Yes (Electric)
No
Unknown at this time
Backup Generator/Battery Backup:
Yes
No
Unknown at this time
If yes, please specify:
Is there anything else you would like us to know?
Submit
Should be Empty: