Thank you for your interest in leasing an electric water heater from The United Illuminating Company. After completing this form a representative from UI will contact you within 48 hours to schedule an appointment for the installation of your new water heater.

Name:*

Address:

City:

Zip Code:

Phone Number:*

Alternate Phone:

E-mail Address:*

*Required

Existing Water Heater Fuel Type:

Size of Existing Water Heater:

Select Size of New Water Heater Desired:

*See Space Requirements Below

Owner Resides at Property Where Water Heater will be Installed? Yes No

Water Heater Space Requirements and Size Information:

Tank Size Tank Diameter Tank Height Family Size

80 gallon 26 inches 58 inches 3-4 adults

120 gallon 28 inches 69 inches 5+ adults

If access is limited, please review to ensure appropriate size is selected.