Service Upgrade Checklist

INFORMATION NEEDED WHEN UPGRADING NON-COMMERCIAL ELECTRIC SERVICE

Customer Number*

Electric Account Number*

First Name*

Last Name*

Spouse/Joint Applicant Name

Current Billing Address*

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 Service Upgrade request)*

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

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

Camper/Travel Trailer

Farm

House

Seasonal Residence

Mobile Home

Well

Other

Type of heat building will have (choose one)

All Electric

Gas Heat

Ground Source Heat Pump

Wood Heat

Air Source Heat Pump

Other

Size of Service needed (choose one)

200 Amp

400 Amp

600 Amp or Greater

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 service upgrade 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 a cover letter and the $150.00 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 your upgrade.

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