New Service Checklist

INFORMATION NEEDED WHEN APPLYING FOR NEW ELECTRIC SERVICE

Customer Number

Electric Account Number

First Name

Last Name

Spouse/Joint Applicant Name

Primary Phone

What type of phone is this?

Home Phone

Work Phone

Cell Phone

Secondary Phone

What type of phone is this?

Home Phone

Work Phone

Cell Phone

Email (Email address will be used to communicate the status updates for your new Electric service)

Physical (911) Address of Property

Location of property: (complete as many as possible)

County, Township, Range and Section (Found on legal land description on property deed)

Closest Town and Road Name

Nearest Electric Service

Nearest Pole Tag # if available

Do you want Co-Mo Connect Fiber Services (Internet and/or Phone)?

Yes

No

Note: If you are interested in proceeding with fiber services, you will need to complete an application online at https://join.co-mo.net.

If "other" please provide info

Square Footage

Commercial: Building service to what type structure (choose one)

If "other" please provide info

Square Footage

If "other" please provide info

Size of Service needed (choose one)

200 Amp

400 Amp

600 Amp or Greater

Single service requiring more than 100 KVA will require a Large Power Contract [Form 01]

Do you want Dusk to Dawn Outdoor Lighting installed? (choose Yes or No)

Yes (Note: Applicant agrees to receive and pay for said service for a period of ONE (1) year from date service is made available.)

No

Right-of-way will be cleared by Member. Service Planning Technicians will advise what right-of-way needs to be

cleared in order to provide electric service and if a notarized Right-of-way Easement is required. The clearing should be 20

feet on each side of the proposed electric line.

Electrician Name & Phone #

Contractor Name & Phone #

If multiple electricians or contractors are bidding this job, please list all names.

By signing this form, you're granting permission to Co-Mo Connect Powered by Co-Mo Electric Cooperative to provide

information regarding this new service request to the electrician(s) and contractor(s) listed above.

Main Applicant Signature

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Joint Applicant Signature

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Please complete and submit this form. You will also need to complete and send an Application for Membership and Electric Service and the Non-Refundable Processing Fee to Co-Mo. Once all of these items are received, a Service Planning Technician will contact you by phone to set up a staking appointment to discuss the installation of your new service.