MEMPHIS
88°
Friday
Partly Cloudy
Current Memphis Weather
MLGW Home Page
Connect with us on Twitter Connect with us on Facebook Read our most recent blog Watch us on YouTube Connect with us on Instagram
Back to Home Page
Residential Electric Service Request
 
Contractor Request Form
Permanent Residential Electric Service

NOTE: Required fields are indicated With a * below. All required fields must be completed for the request to be processed. If you do not have all of the required information, please obtain it before completing this work request.
Service Type
Today's Date:
Friday August 12, 2022
*Installation:
Overhead    Underground
*Type:
New    Added Load
Added load through existing meter number:
Choose One (if applicable):
Meter Separation    Meter Combination
Choose One (if applicable):
Relocate with added load    Relocate without added load
Service Address
*Is the lot in a subdivision?:
Yes    No
*Street Address:
Apt. or Suite:
*City:
*Zip Code:
Subdivision Name:
Lot Number:
Requestor Information
*Your Company:
*Contact Name:
*Contact Phone:
Contact Cell Phone:
Contact Email:
Contact Fax:
Who will pay for this construction? (NOTE: not required in case of DEMOLITION)
*Name:
*Address:
*City, State, Zip:
  
*Phone:
Email:
Monthly Billing Customer Information (please provide if known)
Name:
Address:
City, State, Zip:
  
Phone:
Email:
Electrical Requirements (NOTE: not required in case of DEMOLITION)
Select Voltage:
If "Other", specify the voltage:
Number of Wires:
Wire Size:
  Click here for an example
Electrical Equipment (Enter information below, if new or added load)
Air Condition (Tons):
Light (KW):
Motors (HP): List HP for each motor
Heat Pump (Tons):
Aux Heating (KW):
Receptacle (KW):
Signs (KW):
Welder (KW):
Range (KW):
Water Heating (KW):
Elevator (HP):
Furnace (KW):
Sauna (KW):
Freezer (KW):
Dryer (KW):
Other (Specify):
Special Instructions:
Access Agreement
*You need to send in an Access Agreement for each address. (download by clicking here).