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2. First Name*
3. Last Name*
5. Utility Account Number
   This number can be found on your utility bill and is in this format 000-0000-00-00
7. Address of Service*
9. Mark all that apply*

   Mark each item that you wish to have in the program

   1. Central Air Conditioning
   2. Electric Water Heater
11. Authorization
    I/We hereby apply for participation in the City of St. James Electric Department Load Management Program. I/We understand that this appplication is valid until such time as I/We notify the St. James Electric Department in writing that we no longer wish to participate in the program. The load management device when installed becomes part of the electrical service. Removal of the device may be done only under special circumstances. Removal is at the expense of the property owner. The rebate is $30.00 per item, subject to change. The rebate will be credited to your utility account. In the event the load management device is defective, the City will be reponsible for the replacement of the device and the electrician's service call.
13. Today's Date*
    Today's Date
15. Electronic Applicant Signature *
    Please type your name here. By doing so, you agree to the terms and conditions outlined herewithin.
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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field