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Service Updgrade
Fields (* indicates a required field)
Mr.
Mrs.
Ms.
S.S.#:
Alias
Nickname
Maiden Name
Date of Birth:
Spouse
Co-Applicant
Other
S.S.#:
Alias
Nickname
Maiden Name
Date of Birth:
Mail Bill To:
STREET
CITY
STATE
ZIP
Prop. Physical Address:
STREET
CITY
STATE
ZIP
Home Telephone Number:
(
)
-
OR
Message Number:
(
)
-
Mobile Number:
(
)
-
Fax Number:
(
)
-
Internet/E-Mail Address:
Location Information
Existing PEC Account Number needing upgrade:
Residence or Mobile Home
Barn
Commercial/Oil
Other (Please explain)
Are you the Owner?*
Yes
No
Owner is
Nearest Meter or Pole Tag Number to the location where construction will occur
PEC Pole Tags are 2-3 inch long aluminum tags with a stamped PEC number located on all PEC electric poles.
Driving Directions to Property:*
Gate Code:
Load Information
Total Square Footage being added*:
Please detail type of electrical equipment being added:
A/C Unit :
Standard Hot Water Heater:
Heat Pump with Electric Back Up
Heat Pump with Other Back Up
Central Unit
Window/Other
Tons
Electric
Gas
Propane
Electric On-Demand
Welder:
Compressor:
Yes
No
and size is
Motor HP
Yes
No
and size is
Motor HP
Total Voltage Needed:
Phases requested:
Single Phase
Three Phase
Other load-determining equipment (swimming pool, hot tub, etc.):
Other Comments?
I/We
certifies that the information provided is correct and authorizes the Cooperative to seek past credit history and to release credit history for future inquiries. Consumer agrees to the terms of this Application and Agreement on today's date
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