Step 1 of 2 0% Applicant InformationApplicant Name* First Last Applicant Phone*Applicant Email* Electrician/Contractor Name Membership InformationAre you currently a member?* Yes No Account number / Primary account holder's name*Please enter your account number if you know it, otherwise enter the first and last name the membership is registered under. Service InformationWhich type of service are you applying for?* Residential Service Commercial Service Location of Service* Address Map and Taxlot Layout Address of Service* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Map and Taxlot Layout* Example: 17-04-11-12-08200Phase Type* Single-phase Three-phase Single-phase Panel Size* 200-amp 400-amp 600-amp Single-phase Voltage* 120/240V 240/480V Three-phase Panel Size* 200-amp 400-amp 600-amp 800-amp Over 800-amp Three-phase Voltage* 120/240V 120/208V 240/480V 277/480V Three-phase Service Over 800-amp Size and Voltage*Example 1200amp 480v. Services of this size may not be available in all areas Member Electronic Signature (Full Name)*By signing here you agree that this information is correct.
