Electric Service Request Form A. NEW SERVICE OR SERVICE UPGRADE – Reference MPU Form ED-1049 for General InformationService Address Street Address Address Line 2 Owner of Property First Name Last Name Owner's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Owner's PhoneContractor First Last Contactor's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Contractor's PhoneIf work is billable by MPU, then invoice to:Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneDescription of Service Use Commercial Residential Define type: Residential 1 Family 2 Family Multi-Family Tenant Occupied Owner Occupied Contractor's Planned work Reattach meter base/conduit (only) Repair service equipment Install new service Convert to underground service Relocate existing service Modify service as described: Service ModificationWork Requested of MPU Reseal meter (only) Replace contractor's temp connections Temporarily disconnect service Re-connect service Install and/or energize service Modify service as described: Service Modification RequestedTemporary or Permanent? Temporary Service Permanent Service Underground or Overhead? Underground Overhead Voltage Requested 120/240, 3W 120/208, 4W 277/480, 4W Primary If service is larger than 200 amps, then furnish MPU Form ED-1023Main Disconnect Size & AIC RatingService Entrance Wire Size/TypeResidential Units: This property has electric... Air Conditioning (fixed in place) Hot Water Range Clothes Dryer Heat Geothermal Electric Vehicle Charger Upload a sketch to indicate requested meter location(s)Max. file size: 512 MB.Comments / Project Dates RequestedCIS Service Order # (Assigned by MPU) B. ELECTRICAL INSPECTION -MINIMUM 48 HOURS ADVANCE NOTICE IS REQUIRED BY ELECTRICAL INSPECTORElectrical Inspector: I have inspected the work and the service may be supplied by the utility.HiddenSigned: HiddenDate MM slash DD slash YYYY Note: A licensed Master Electrician may sign for modifications to existing residential services located outside of Manitowoc. Disclosure: If customer information is to be shared with another party, please complete a Customer Consent Form. If tax exemptions apply, then provide Form S211 Wisconsin Sales & Use Tax Exemption Certificate FORM ED-1050 REVISED 04/01/2021 Download a PDF version of this form
