ELECTRIC SERVICE REQUEST FORM- NEW SERVICE
Fax: 1-800-882-0322 Email: [email protected]
CUSTOMER FULFILLMENT: Phone: 1-800-260-0054
Customer Information: CURRENT ACCOUNT or CUSTOMER NUMBER ___________________________________ Customer/Business Name: Phone: Mailing Address: House #: Street: Town/City: State: Zip: Service Address: *911 addresses are required for all new services; these can be obtained from your local sheriff department or town office House #: (If URD) Lot #: Street: Town/City: State: Zip: Meter #: Nearest Neighbor: *only applicable if first home on new street House #: (If URD) Lot#: Street: Meter #: Contractor Information: *PLEASE CHECK þ YOUR PREFERRED METHOD OF CONTACT Company: CONNECTS PROGRAM MEMBER? YES ☐ NO ☐ Contact Name: Phone: Extension: Email: Fax: Service Order Information: *please provide a brief description of the work being performed; þ ALL THAT APPLY RESIDENTIAL COMMERCIAL New Service Temporary Service (EX: New Service for temporary construction trailer; new single meter service for modular home / trailer / house) Service Characteristics: *when upgrading or requesting new service for Multiple Dwelling Units please refer to the second page and indicate how units will be labeled Ex: additional meters for an apartment complex or strip mall Overhead: Underground: Underground Development: Name of Development: If Underground what is the service fed from: pole: hand hole: pad: Amps: Voltage: / Single Phase: 3-­‐Phase: Total Electric Meters: What is the meter socket attached to: House Pedestal Meter pole New Gas Service: Yes No Total BTU/CFH load: Total Gas Meters: Please fill out all necessary information completely and legibly. ANY INCOMPLETE ORDERS WILL NOT BE PROCESSED ELECTRIC SERVICE REQUEST FORM- NEW SERVICE
Fax: 1-800-882-0322 Email: [email protected]
CUSTOMER FULFILLMENT: Phone: 1-800-260-0054
Distance of pole line from point of attachment? Is the drive way cut in? Yes: No: Has the building been framed? Yes: No: Has the foundation been poured? Yes: No: Is this a second service (separate service and meter in addition to existing structure)? Yes: No: Is the electrician doing his own work? Yes: No: Multiple Dwelling Units: Please tell us how you will be labeling your meters and make sure that it matches the number of meters requested Ex: Building A, Apartments 1-­‐10; Suites 1-­‐4; 1 House Meter & Units A-­‐D Please fill out all necessary information completely and legibly. ANY INCOMPLETE ORDERS WILL NOT BE PROCESSED