Request for Service Upgrade Form

Name of Account Holder:

Account Address:

Email (optional):

Phone:

Contractor Name:

Contractor Address:

Contractor Email: Must provide at least a Contractor Email or Contractor Phone

Contractor Phone: Must provide at least a Contractor Email or Contractor Phone

Who is responsible for layout costs?

Who is responsible for construction costs?

When will you be ready to upgrade your service?

Is this a Residential, Seasonal or General service?

Meter Number: Note: Must start with "J", followed by 7 digits

Existing Service Size (in Amps):

Is the existing service overhead or underground?

What size will the new service be? (in Amps)

What voltage will the new service be?

Will the new service be overhead or underground?

Will this be a Gas, Electric or Other type of heating?

For Other heating types, please specify:

Will there be an electric water heater?

Yes No

To the best of my knowledge, the information contained in this form is accurate and complete.