Voluntary Time-of-Use Rate Application Form

* indicates required fields

Customer Name:

Address:

City/Town:

State:

Zip Code:

Account Number:

Please enter a valid value in the format of 12345-67890

Customer Email:

Phone:

Please enter a valid value in the format of 999-999-9999

THE UNDERSIGNED (“Customer’) hereby applies to NATIONAL GRID (“Company”) to supply electric service upon the above premise and account number for the period of one year from the following date until cancelled upon written notice to the Company.

Date

Customer agrees to observe and perform all rules and regulations of Company and to pay the rates provided by Service Classification No, SC-1, Special Provision L, filed with the Public Service Commission of the State of New York as the same may be from time to time changed, amended and/or supplemented. If you own a plug-in electric vehicle then you have the option of receiving a one-time comparison of one year of charges on the SC-1 VTOU rate versus the SC-1 standard tariff. You must provide the Company with a copy of the vehicle registration at your residence to be eligible for this one time comparison. It will be based on the 12 month period beginning with the bill period following the Company’s receipt of your vehicle registration. If this comparison indicates that you would have paid less on the SC-1 standard tariff rate, the Company will provide you with a one-time bill credit for the difference. At that time, you may choose to stay on SC-1 VTOU or move to the SC-1 standard tariff or the SC-1C Optional Large Time of Use rate.

Yes, I would like to apply for National Grid’s SC-1 Voluntary Time-of-Use rate. *

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Voluntary Time-of-Use Rate Application Form