UGI Utilities » Contact Us » UGI Electric Service New Residential Service Request Form

New Residential Service Request Form

After the application is processed you will be contacted and notified of any deposits or construction costs required to energize the service. All associated costs must be paid in full before the service will be energized. Please allow 5 business days for processing (unless all fields are completed, form cannot be processed.). All Fields are Required. UGI Electric Service is available in regions of Luzerne and Wyoming counties. View tariff for details.
JOB INFORMATION / SERVICE LOCATION

Customer Name:*
Street:*
City:*
ZIP:*
Township/ Borough:*
Contractor Name:
Contractor Phone #
Electrician Name:
Electrician Phone #
Contact Name:*
Contact Phone:*
E-Mail Address:*
Confirm E-Mail:*
BILLING / MAILING INFORMATION
Customer Name as it will appear on the UGI bill:*
Street:*
City:*
ZIP:*
Social Security#*
Customer Phone #:*
May we perform a credit check?* Yes
HOME INFORMATION

Heating System (Select One)

Gas


 Electric Oil Other

Water Heater (Select One)

Gas Oil Electric Other

Stove (Select One)

Gas Electric

Clothes Dryer (Select One)

Gas Electric None
SERVICE INFORMATION

Type of Service (Select One)

Overhead Underground

Size (Select One)

100A 200A 400A Other

Date service is requested:

Closest Grid / Pole Number:

10 digit number on the pole (5 digits and a break and 5 digits)

Other Information:

Please be sure the information entered above is correct. The form you are about to submit will not be encrypted for privacy.  You may continue by clicking Submit.