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Application for Electric Service

Name: Application for Electric Service
SKU: 1675
Price: 30.00 USD
Availability: InStock

$30.00

Fill out the form below or download and print the PDF and return to Merrimac Light. This application is a legal contract between the applicant for electric service and the Town of Merrimac. Application fee: $30

Application for Electric Service Downloadable Form

First Name *

Middle Initial

Last Name *

Date of Birth *

Email *

Phone *

Service Address *

Is your billing address the same as your Service address? *

Yes

Billing Address *

Authorization Number

Lot Number

Pole Number

Service Type *

Temporary Service

Permanent Service

Service Upgrade

How will you heat hot water? *

Electric

Natural or Propane Gas

Oil

Type of Heat *

Electric

Natural or Propane Gas

Oil

Service will be *

Overhead

Underground

Test

Number of Meters *

Electrician Full Name *

Electrician License Number *

Electrician Phone Number *

Contractor Full Name *

Contractor Business Address *

Contractor Phone Number *

I agree to the Policy & Schedule of Charges *Read the Policy & Schedule of Charges

I agree

Please be aware of, and use MMLD specifications. Upon completion of this form, MMLD will issue a meter location. Upon approval from Wiring Inspector and payment of any related fees, MMLD will connect service. *

I understand.

Application for Electric Service quantity

Category: Administrative Fees

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MERRIMAC MUNICIPAL LIGHT DEPARTMENT

10 West Main Street | Merrimac, MA 01860
Phone: (978) 346-8311 | Fax: (978) 346-8312
Email: office@merrimaclight.com
Open Monday – Friday 7:30am – 4:00pm

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Application for Electric Service

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