Request for New Service or Service Upgrade Form Home » Request for New Service or Service Upgrade Form Please complete and submit this form for any disconnect/reconnect, upgrade, temporary and new service request.Customer Name:(Required) Customer Service Address:(Required) Customer Phone #:(Required)Email:(Required) Contractor/Electrician:(Required) Phone:(Required)Contact Name:(Required) Email:(Required) Mailing Address:(Required) Please note a Connection Agreement Form will need to be completed for all New Services.Service Request DetailsService Details (Check One):(Required) New Service Service Upgrade Service Type (Check One):(Required) Overhead Underground Anticipated Demand Load: Existing Service:Amps: Volts: Phase: Wire: Proposed Service:Proposed Amps:(Required) Proposed Volts:(Required) Proposed Phase:(Required) Proposed Wire:(Required) Preferred In - Service Date:(Required) MM slash DD slash YYYY Metering Type:(Check One) Single Meter Multiple Meters # of Meters to be Installed:100A or Less: 101A to 200A: More than 200A: Comments:Name:(Required) Title: Date:(Required) MM slash DD slash YYYY Signature(Required) I agree.
