New Construction New Construction ApplicationA $300.00 deposit may be required New Service Location Information New Service Address Address Unit, Apartment # City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code What would you like the meter description to be? Overhead or Underground? - None -OverheadUnderground Estimated Square Footage Heat Type - None -GasElectricOther Voltage - None -OtherSingle Phase 120/240Three Phase 277/480Three Phase 2400/4160Three Phase 120/280 Service Size - None -200 amp400 ampOther Electrical Contractor Contact Person Electrical Contractor Phone # Township, Range, or Section # (if known) Have you spoken to our Staking Department regarding the construction of this service already? Yes No Applicant Information Will the service be established and billed under an Individual/Personal name or a Business/Commercial/Organization? Individual Business Full Name First Name Middle Initial Last Name Social Security # Would you like to add a Join Account Holder? Yes No Business/Commercial Business Name Federal ID # Contact Person Joint Applicant Information Full Name First Name Middle Initial Last Name Social Security # Relationship to Applicant Contact Information Primary Phone # Secondary Phone # Email Address Where would you like your monthly bill to be sent? Same as Service Address Different Address Mailing Address Address Unit, Apartment # City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code How would you like to receive your bill? Paper only Email only (you will receive an email to register with SmartHub once your app is processed) Both Paper and Email (you will receive an email to register with SmartHub once your app is processed) Other information regarding this application Operation Round Up Operation Round Up Yes, I'd like my bill rounded up for charitable community purposes. (Maximum per year: $11.88) No Operation Round Up is a voluntary program where a member may have their electric bill rounded up to the nearest dollar. Charitable contributions received through Operation Round Up are distributed via application for educational, scientific, health or safety purposes in our community. Those in need appreciate your commitment! Acknowledgement and Signature Signature Sign above Type Signature Application Date Terms of ServiceMcKenzie Electric Cooperative Bylaws I agree to McKenzie Electric Cooperative's Terms of Service and acknowledge that I have been provided access to review the Bylaws.
