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Temporary Electric Service Request
Contractor Request Form
Temporary 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 Information
Today's Date:
Friday August 12, 2022
*Service Status:
Install    Remove
Temporary Service Type
*Select One:
MLGW Underground Pedestal (unmetered) 120V
MLGW Overhead Temporary (metered) 120/240V
Underground By Customer (metered) 120/240V
Overhead By Customer (metered) 120/240V

If other from above, please list:
Service Address (If requesting multiple installs or removals, enter the appropriate information in the spaces at the bottom of form)
*Is the lot in a subdivision?:
Yes    No
*Street Address:
Apt. or Suite:
*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 REMOVE)
*City, State, Zip:
Electrical Requirements (NOTE: not required in case of MLGW Underground Pedestal or Overhead Temporary Service Types)
Number of Wires:
Wire Size:
  Click here for an example
Special Instructions:
Multiple Meter Installs: (use the space(s) below to enter Address and Meter Numbers)
Enter Addresses and Lot Numbers:
Enter Addresses and Meter Numbers:
Access Agreement
*You need to send in an Access Agreement for each address. (download by clicking here).