Electric Service Request Form
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1Electric Service Request Form
Contractor/Consultant Contact Information
Contractor/consultant name __________________________________________
Contact person ____________________________________________________
Day phone # _________________________
Cell phone # ______________________ Fax # _____________________ Best contact time: ____________
a.m.
p.m.
Customer (Owner) Contact Information Complete this section if owner and contractor are separate individuals
Name _______________________________________________________________________________________________________
Mailing address ________________________________________ City, State Zip ___________________________________________
Day phone # ____________
Cell phone # _______________________ Best contact time: ____________
a.m.
p.m.
Billing Information
Person requesting service is
owner
other
Check if you want a separate billing statement for this site
Person responsible for billing is
owner
other (if other, please fill out both sections above)
Account #_______________________________________ Tax ID #_____________________________________________________
Complete fields below if person responsible for billing has not had service with Pacific Power
Name _______________________________________________________________________________________________________
Mailing address _________________________________________ City, State Zip __________________________________________
Complete fields below if not billing to a business account
Social Security # ______________________ Date of Birth _______________ Driver’s license # ______________ State ____________
Day phone # ______________________ Cell phone # ______________________ Work phone # _____________________________
Alternate customer _______________________ Social Security # __________________ Date of birth__________________________
Driver’s license # __________________ State ______ Day phone # _________________ Cell phone # _________________________
Service Information This section is required
New service address ________________________________________ City, State Zip _______________________________________
New service address coordinates (if applicable) _______________________________________________________________________
Subdivision name ____________________ Phase _______________ Lot # _______________ Block # __________________________
If known, nearest pole or padmount # (yellow tag, 10 or 12 digits) ________________________________________________________
Type of service
residential
non-residential
sq. ft ___________
sq. ft ______________
House (residence, cabin)
Warehouse
Mobile home
size ____________
Irrigation pump
HP rating___________
sq. ft ___________
sq. ft ______________
Garage/outbuilding
Other (barn, cell tower, RV pad)
sq. ft ___________
# of units __________________
Apt./condo/townhouse
Special conditions and/or requests (call back, cost estimate, temp or perm location, etc.) ________________________________________
Main source of heat
gas
propane
other
electric If electric
heat pump (___ tons)
furnace
other
)
If air conditioning
evaporative cooler
central air (___ tons
heat pump (___tons)
other
Preferred service type (a fee may be charged for temporary service)
permanent
temporary for construction
If you are going from temporary to permanent service, the temp meter should be
left
removed
State/City electrical inspection complete?
yes
no
n/a permit # ____________________
Expected building completion date (mm/dd/yyyy) ______________________________
Applicant or representative signature
date
Please fax completed form to 1-800-883-3124.
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Parent category: Business