Customer Information Sheet
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1GMP Customer Information Sheet
Project Number: ______________
District: ___________________ Town: _____________________ Line: ________ Pole#/Taglet#: _________________
Complete this form and bring it to your appointment or email it to your local Designer (see contact list)
Customer Name:
Is this New Service?
Residential: _______ Commercial: _________ Stand Alone Solar: ___________
Customer Phone Number:
Work: ______________
Home: _____________ Cell: _______________
Customer Email Address:
Customer Billing Address:
911 Address of New Service:
Current GMP Customer?
No ________ If Yes, please provide Account Number: ______________________
What type of Service are
you requesting?
Overhead: ___________
Underground: ___________
Where will your new Meter
be Located?
On Building: ______ On Pedestal: ______ Other: ______________________________
Are you Tax Exempt?
No: __________ If yes, Please provide Tax Exempt Number: _____________________
Additional Comments:
Please Note: There is a $20 Administrative Fee for setting up a new service account.
__________________________________________________________________________________________________
ONLY Complete this section if GMP requires a New Right-of-way Easement for New poles or Structures
Property Owner as it appears on
the Deed:
Grantor (Seller) of Property:
City/Town Deed Recorded In:
Date of Deed:
Book and Page of Deed:
Book: ______________
Page: _______________
GMP Distribution Designer Name: ________________________________________
Contact Number: ___________________________
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