Request for Electricity Today's Date Type of Service Requested Existing - Purchasing Property Existing - Renting Property New Construction (no existing electrical service) If renting, name of landlord If renting, landlord phone number Date Electricity is to be transferred or connected Are you now or have you been a member of H-D Electric Cooperative before? Yes No Primary applicant name Primary applicant phone number Primary applicant email Co-applicant name (if applicable) Co-applicant phone number Co-applicant email Service address legal description (Ex: SW1/4 15-115-50) Service 911 address (Ex: 18000 440th Ave) Service City Service State Service Zip Code Is the mailing address the same as service address? Yes No Mailing Address (if different from service address) Mailing Address - line 2 Mailing Address City Mailing Address State Mailing Address Zip Code Additional Information you would like us to know CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
