Application for Electrical Service

Must be filled out completely by Electrical Contractor

Street Address of Job Location

Electric Service Billing Address

Business Type

Owner Phone Number

Electrical Contractor Name

Contractor Email

Project Estimate

Estimated Start Date *

Estimated Completion Date *

Job Type/Description

Service Size

Main Service Size (Amp) *

Service Entrance Wire Size & Type *

Service Status

Temporary

Permanent

Service Infomation

Number of Meters/Services *

Single or Three Phase *

Service Voltage *

Contractor/Owner Notes

Contractor Signature & Date

First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

REQUIRED: Site sketch or file upload to include complete detail of lot including: roadways, structure, location, pole/pedestal location, approximate distances, proposed routes and all other utility line locations including: propane/natural gas, water, sewer, electric and communication facilities.

Site sketch or file must be filled out before service location will be approved and any excavation occurs.

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Site Sketch

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