Step 1 of 6 0% LinkedInThis field is for validation purposes and should be left unchanged.Should you require a service larger than 200 amps single phase or three phase, please contact the New Construction Department at (580) 332-3031.The following information will be required to proceed with the application. Name, Date of Birth, Social Security Number of all persons who will be listed on the account. Meter number (if applicable), pole number, or legal description of the location where construction is to take place. Load Information. Type of equipment that will be installed. Voltage, amps, and phase requesting. Photocopy of I.D. Applicant InformationName(Required) First Last Social Security Number OR FEIN/Tax ID(Required)Company Name (if applicable)Type of Business(Corporation, Partnership, etc.)FEIN or Tax ID(Required)Date of Birth (mm/dd/yyyy) Month Day Year Physical Address of Property (if available)(Required) 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 Billing Address(Required) Same as previous 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 Best Contact Phone Number(Required)By selecting yes below, you agree that PEC may send you SMS text messages concerning your account, payment, balance due, and/or the status of our services to you. Between 8pm and 8am we will only send you messages to update you on any interruption of your service. We will never attempt to sell you any new or different services in any text messages we send to you. Data and messaging rates imposed by your cellular service or internet provider may apply. You may opt-out of this feature of our service by selecting no below. Our complete data privacy policy is at https://www.peopleselectric.coop/privacy/(Required)Text messages will only be sent to mobile phone numbers and will not be available for landlines. Yes No Secondary Contact Phone Number(Required)By selecting yes below, you agree that PEC may send you SMS text messages concerning your account, payment, balance due, and/or the status of our services to you. Between 8pm and 8am we will only send you messages to update you on any interruption of your service. We will never attempt to sell you any new or different services in any text messages we send to you. Data and messaging rates imposed by your cellular service or internet provider may apply. You may opt-out of this feature of our service by selecting no below. Our complete data privacy policy is at https://www.peopleselectric.coop/privacy/(Required)Text messages will only be sent to mobile phone numbers and will not be available for landlines. Yes No Do you have a co-applicant?(Required) Yes No Name(Required) First Last Social Security Number(Required)Date of Birth (mm/dd/yyyy)(Required) Month Day Year Email(Required) Location InformationType of Construction(Required) Residential Mobile Home Barn/Shop Commercial/Oil System Improvement PEC Will Require the 4 Corners of the Structure Be Marked as Well as an Accessible Driveway to the Site. Has This Been Completed?(Required) Yes No Are you the owner? Yes No Landowner Name First Last Landowner Mailing Address 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 Driving Directions to Property(Required)Nearest Meter or Pole Tag Number to the location where construction will occur. PEC pole tag numbers can be between 4 to 8 numbers. They are either stamped on the pole or attached with an aluminum tag.Pole or Meter Number?(Required) Pole Number Meter Number Pole Number(Required)PEC pole tag numbers can be between 4 to 8 numbers. They are either stamped on the pole or attached with an aluminum tag.Meter Number(Required)Total Voltage NeededAmps1 or 3 phase Construction InformationApproximate Total Square Footage(Required)Total Electric(Required) Yes No A/C Unit(Required) Heat Pump with Electric Back Up Heat Pump with Other Back Up Central Unit Window/Other Mini Split (Hotel Unit) None A/C Unit Tons(Required)Hot Water Heater(Required) Electric Gas Propane Electric On-Demand Propane On-Demand None Range(Required) Electric Gas Propane None Other load-determining equipment(Required)(swimming pool, hot tub, outside cooking area etc.)Security Lights Requested Yes No How Many? Construction InformationApproximate Total Square Footage(Required)A/C Unit(Required) Heat Pump with Electric Back-Up Heat Pump with Other Back-Up Central Unit Window/Other Mini Split (Hotel Unit) None A/C Unit Tons(Required)Heat(Required) Yes No Type of Heat(Required) Wood Propane Electric Welder(Required) Yes No Compressor(Required) Yes No Total Horsepower of Motor on Oil Leases(Required)Number of Lights Installing and Type of LightsAny Other Type of Tools or Large Equipment?(Required) Yes No Please explainSecurity Lights Requested Yes No How Many? Construction InformationApproximate Total Square Footage(Required)A/C Unit(Required) Heat Pump with Electric Back Up Heat Pump with Other Back Up Central Unit Window/Other Mini Split (Hotel Unit) None A/C Unit Tons(Required)Other load-determining equipment(Required)(swimming pool, hot tub, outside cooking area etc.)Security Lights Requested(Required) Yes No How Many?(Required)Please Fill Out Either Section A or BSection ATotal Electric Yes No Hot Water Heater Electric Gas Propane Electric On-Demand Propane On-Demand None Range Electric Gas Propane None Section BHeat Yes No Type of Heat Wood Propane Electric Welder Yes No Compressor Yes No Number of Lights Installing and Type of Lights Copy of Driver's License or Photo ID Drop files here or Select files Max. file size: 256 MB. Signature & Consent Read the full Terms & Conditions of Service.Applicant Consent(Required) I hereby verify the above information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.I authorize the Cooperative to seek past credit history and to release credit history for future inquiries. Consumer agrees to the terms of this Application and Agreement on today's date.Applicant and Co-Applicant Consent(Required) We hereby verify the above information to be true and complete and agree to the terms and conditions. We understand that by typing our full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by us as if we had signed our signature.We authorize the Cooperative to seek past credit history and to release credit history for future inquiries. Consumer agrees to the terms of this Application and Agreement on today's date.Applicant Electronic Signature (Full Name)(Required)Co-Applicant Electronic Signature (Full Name)(Required)
