Temporary Service

Temporary Service For Construction Sites

Use this form to request electrical service during construction.

Customer Information

Email address:

Customer name:

Is this a legally registered name?

Additional customer name (store #, asset#, etc.):

Site address:

City:

State:

Zip:

Directions to site:

Mailing address:

City:

State:

Zip:

Federal ID Number:

DUNS Number:

Customer contact name:

Cust. contact day phone:

Cust. contact pager number:

Cust. contact cell phone:

Cust. contact pager email address:

Cust. contact evening number:

Cust. contact fax number:

Cust. contact email address (if different from above):

Contractor Information

Email address:

Contractor name:

Company name:

Contractor mailing address:

City:

State:

Zip:

Contact day phone:

Contact pager number:

Contact pager email address:

Contact cell phone:

Contact evening number:

Contact fax number:

Contact email address (if different from above):

Preferred method of contact:

New Construction Details

Requested ready date:

May 2014

Service type:

Overhead service
Underground service

Approximate distance from nearest pole with transformer (overhead service) or transformer enclosure (underground service):

Details about new construction request:

Learn what you must know about working safely around electrical facilities.

Safety for Contractors

Temporary Service