Contractors

* = Required Fields

 

Please fill out the form below:

*Owner:
*Address:
Building #:   Apt #:
*City:
*Phone:
Cell Phone:
*Email:
Bill To:
Billing Address:
City:
State:   Zip:
Phone:
*Contractor/Owner :    *CT Electrical License#:
Social Security #:
*Last Name:
*First Name:
*Address:
*City:
*State:   *Zip:
*Office Phone#:
Fax#:
Pager#:
Email:
 *Service Request Type
New:
Replace:
Increase:
Remove:
Demolition:
* Notarized letter REQUIRED
  Yes No
*Meter Work ONLY:
*Residential:
*Temp Post or Trailer:
*Service Wires Overhead:
*Elec-heat:
*Cent A/C:
 Service Size
Amps:    Volts:
*Phase:    *Wires:
 New Overhead
Temporary Service Permanent Service
Pole has UI Sec Svc: Y    N
Service Pole#:
Nearest Pole # With Transformer:
# Spans to Pole With Transformer:
# FT (Pole to home):
Need UI to Field Check Service: Y    N
Are there any existing Meters? Y    N
How Many New Meters?

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