EmailThis field is for validation purposes and should be left unchanged.Customer Location & Contact InformationName(Required)Deed holder of the property First Last Current Mailing Address(Required) Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code 911 Address of New Service Location (If Known)(Required) Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Daytime Phone(Required)Cell PhoneEmail Address Current CVEC Member Yes No Account NumberCounty(Required)SubdivisionLot NumberTax Map/Parcel #(Required)Directions(Required)Including name of closest adjoining property ownerNew Service Required? New Construction Upgrade of Existing Service New ConstructionNew:(Required) Residence - Must have building permit, deed, plat, and well and septic permit Commercial - Any service that is not a residence, ie: barn, garage, agricultural. Must have deed and plat Estimated Square Footage of HouseService Size (Amps)(Required)Meter Location(Required) Service Pole On Structure Heating System Type(Required) Dual Fuel Electric Gas Geothermal Heat Pump Propane Other Cooling System Type Central Heat Pump Other Number of Systems 1 2 3 4 5 Water Heater Type Gas Electric Other 4 Corners of Building Marked and Driveway Roughed In?(Required) Yes No If No, contact Field Engineering Department when completed, (800) 367-2832, extension 5554.Contractor's Name(Required)Contractor's Phone(Required)Type of Service(Required) Overhead Underground (Consumer responsible for trenching) Will You Need Temporary Service?(Required) Yes No Upgrade of Existing ServiceSize (Amps) of Existing Service(Required)Size (Amps) of New Service(Required)Additional Load Such as New Heat Pump, Addition, Etc.?(Required) Yes No This field is hidden when viewing the formSection BreakCommentsUpload Documents Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 100 MB.
