Northgate Residents Sign-On Application for Services Sterling Municipal Light Department 5 Northgate Residents Sign-On Application for Services "*" indicates required fields EmailThis field is for validation purposes and should be left unchanged.Name*Last 4 Digits of SSN*Secondary NameEmail* Service Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date for Service to be Turned on: Type of Customer Owner Tenant Mailing Address (if different) Mailing Address (if different) Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ElectricBilling Preference EMAIL STANDARD Payment Confirmation EMAIL TEXT Outage Notification and Restoration Preference EMAIL TEXT At the rate and subject to Terms and Conditions as filed from time to time with the DPU of Massachusetts. I agree to abide by all rules and regulations of the Sterling Municipal Light Department and further agree to grant free and easy access to all property belonging to the SMLD. (Accordance with MGL Chapter 164 Section 58.A) **METER DEPOSIT REQUIRED FOR TENANTS ONLY*Electric Rate Type Residential Community Solar Time of Use Controlled Service Join the Neighbor-To-Neighbor Program. Round your bill to the nearest dollar to help Sterling Residents during difficult economic circumstances. FiberFiber Service Plan YES NO Payment Confirmation EMAIL TEXT Fiber Bills are sent electronically to the email(s) provided. If you require a paper bill you will receive a monthly paper bill charge of $2.00 EMAIL STANDARD Join the Neighbor-To-Neighbor Program. Round your bill to the nearest dollar to help Sterling Residents during difficult economic circumstances. Please select: Type | Speed up/down | Monthly Cost Silver 250Mb/s $65.00 Gold 500Mb/s $80.00 Platinum 750Mb/s $90.00 Diamond 1Gb/s $105.00 Mesh Extender Mesh Extender Rental $9.95 LAMB installation turnup fee: We have a $200.00 installation fee or requested you agree to a two-year contract. If you terminate service before the two-years are up, you will have a termination fee of the 200.00 installation fee minus the time you were on the service please check one of the boxes. Installation Fee 2 year contract Please Attach Copy of Drivers License Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, heic, heif, Max. file size: 25 MB, Max. files: 2. Signature*Date* Setting up for ACH Payments*This section is not required.Bank Account Electric Fiber Both Bank Account for ElectricBank NameName on AccountRouting NumberAccount NumberAccount Type for Both Electric and Fiber Checking Account Savings Account Bank Account for FiberBank NameName on AccountRouting NumberAccount NumberAccount Type for Both Electric and Fiber Checking Account Savings Account Bank Account for Both Electric and FiberBank NameName on AccountRouting NumberAccount NumberAccount Type for Both Electric and Fiber Checking Account Savings Account Meter Deposit ChargeWould you like to add your meter deposit charge to your first bill? Yes No A meter deposit in the amount of $250.00 is required to open the account for service. This deposit is held on your account until the account is closed. Once the account is closed the deposit is applied to your final bill. You will be responsible for any charges not covered by the deposit or a refund will be issued if there is a credit balance remaining. This payment can be made in the form of cash or check. You can also choose to have this charge put on your first bill. If you decide to take the bill option, the meter deposit charge must be paid on the due date on your first bill. Failure to make this payment will result in interruption in service until the payment is received and will also include a reconnect charge prior to service being reinstated. Please complete and sign if you would like the $250.00 meter deposit charge put on your first bill. Please call us at 978-422-8267 if you have any questions.Date* Name* First Last Address*Local Area Municipal Broadband (LAMB) Affordability Program ApplicationWould you like to sign up for LAMB's Affordability Program (150mbs for $50.00)? Yes No LAMB Affordability Agreements* Yes, I would like to apply for LAMB’s Affordability Program (150mbs for $50.00) I authorize the agency(s) providing my benefits to release information to LAMB for the purposes of enrollment, for the annual recertification for the Rate. I also understand that I must notify LAMB if my benefits are discontinued. LAMB Account #Social Security #*Name*Street Address*Phone*Email* Eligibility Criteria for the Affordability rate: You are a residential customer. Your Fiber Internet bill is in you rname. You are over the age of 65 (proof of age) You are a Veteran. You or someone in your home has a disability. You are currently receiving benefits under a Means-Tested Program. I receive benefits from the following program(s): Disabled, and Children (EAEDC)* Food Stamps (SNAP) Head Start MassHealth (Medicaid) National School Lunch Program WIC Public Housing School Breakfast Program Supplemental Security Income (SSI) Transitional Aid to Families with Dependents Children (TAFDC) Veterans Service Benefits* (Chapter 115) Veterans DIC Surviving Parent or Spouse Military ID Veteran's Non-Service Disability Pension Fuel Assistance Supporting Documents Upload* Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, heic, gif, Max. file size: 25 MB, Max. files: 5. Please provide proof of benefits. Acceptable forms of proof include a program I.D. card or a copy of the certifying agency's acceptance letter.Certify Info* I certify that all the information provided on this application is true. I receive benefits from the program(s) indicated and the LAMB residential account above is in my name, and I am eligible. Sterling Neighbor to Neighbor FundWould you like to sign up for the Sterling Neighbor to Neighbor Fund? Yes No Please make sure to choose another option above under Electric Rate Type before you continue, if you are not interested in enrolling in the Neighbor to Neighbor Fund.Name* First Last Address*Phone*Email* Number of Family/House Members and AgesCurrent monthly incomeAnnual income for the past yearCurrent balance in savings accountsCurrent balance in checking accountsAre you or an family/household member a veteran? Yes No Supporting Documents Upload*REQUIRED: Please include with your application a statement indicating your circumstances and reasons for requesting assistance, with copies of documents supporting your request, including proof of residency for at least one year and monthly bills and expenditures.PLEASE NOTE: 1) YOUR APPLICATION WILL NOT BE COMPLETE AND CANNOT BE CONSIDERED WITHOUT THIS STATEMENT AND 2) COPIES OF DOCUMENTS SUBMITTED WILL NOT BE RETURNED. Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, teic, gif, doc, docx, rtf, Max. file size: 25 MB, Max. files: 6. SignatureDate*
