Application for Third Party Notice

By completing this form, I request that the third party (person or
agency) named below be notified of any Non-Payment Disconnect Order
issued by Delmarva Power against my account.


     Customer Name __________________________________________

    
    Delmarva Power
    Account Number __________________________________________


           Address __________________________________________


             Phone __________________________________________


              City __________________________________________


             State __________________________________________


               Zip __________________________________________



Customer Signature __________________________________________


  Third Party Name
       (person or
           agency) __________________________________________


           Address __________________________________________


             Phone __________________________________________


              City __________________________________________


             State __________________________________________


               Zip __________________________________________


      Signature of
       Third Party __________________________________________