New Service Request Application

Current General Information
Services Needed
Document Download
Complete

CONTACT INFORMATION

First Name

Last Name

Current Mailing Address

City/Town

State/Province

ZIP/Postal Code

Phone No.

Alternative Phone No.

Email

BUILDING SITE INFORMATION

New Service Address

Enter the address of where you are needing the utility services added.

City/Town

State/Province

ZIP/Postal Code

City/Town/Village (check one)

City

Town

Village

Other…

Subdivision Name

Lot No.

County

Square Footage of Building

Class of Construction

BILLING INFORMATION

Who should be billed for installation?

Builder

Building Owner

Who should be billed for utility usage during construction?

Builder

Building Owner

CONTRACTOR INFORMATION

Builder/Contractor Name

Contact Person Name

Federal Tax I.D. No.

Builder/Contractor Phone No.

Builder/Contractor Fax No.

Contractor Email

Builder/Contractor Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Electric Contractor Name

If not applicable type N/A

Electric Contractor Phone No.

Heating Contractor Name

If not applicable type N/A

Heating Contractor Phone No.