All Services Application
Revised Application

Residential or Commmercial*
(press to select)"

Residential

Commercial

Name *
(Builder or Owner/Builder)

Phone *

LCEC Account Number *

Billing Address1 *

Billing Address2

Billing City *

Billing Zip *

Billing Email

Service Address1 *

Service Address2

Service City *

Service Zip *

Service Strap *

Service Block *

Service Lot *

Service Subdivision *

Renewable Generation
Present *
(press to select)

Service Description *
(additional data fields may appear)

Service Requested *
(additional data fields may appear)

Permit Number *
Main Panel Size *
Voltage Description *	Select One 120/208v-(208/120)-3ph 120/208v-1ph Network 120/240v-1ph 120/240v-3ph (Open Delta Only) 240/480v-3ph (Open Delta Only) 277/480v-(480Y/277)-3ph
A/C Square Footage *
A/C Units-Number *
A/C Units-Size(s) *
Heat Strip Size(s) *
Field Supervisor *
Field Supervisor Phone *
Electrician Name *
Electric Office Phone *
Electrician Cell Phone *
Please be advised the following minimum charges apply on new service applications: Initial Construction Charge $200, System Infrastructure Charge $250
I have read and understood the charges
Comments

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