Submit New Service Request

If you are in need of new electric service at a location (which has never had a meter and electric lines located on the site), complete and submit this form or contact the office by calling 1-800-762-0997 during our business hours of 8:00am - 5:00pm, Mon. - Fri. After submitting the form an employee will contact you in 1 to 2 business days. You will need to complete a membership application form also. If you are moving to a location which already had electrical service, you will only need to fill out a membership application.

First Name:*

Last Name:*

Current Mailing Address:

City:

State:

Zip:

New Service Address:

City:

State:

Zip:

E-mail Address:*

Consumer Home Phone Number:*

Consumer Business Phone Number:

Building Contractor:

Building Contractor Phone Number:

Currently a Member? Yes No

If Yes, please enter Account Number:

Temp. Service Requested? Yes No

Construction Date: Open the calendar popup. << < May 2012 > >> S M T W T F S 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Time Picker 12:00 AM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM

County:

Township:

Driveway In? Yes No

House Staked? Yes No

* = Approval from County Required prior to appointment scheduling

* Location of Well? Yes No

* Septic Yes No

* Leach Field? Yes No

Type of Residence: Framed Home (Stick Built) Modular Mobile Home Other

Sq. Ft. of Floor Space:

Type of Heating:

Air Conditioning: None Central Air Other

Water Heater: Electric Gas Other

Comments: