UGI Utilities » Contact Us » UGI Electric Service New Construction Commercial Service Request Form

NEW TEMPORARY 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. There is a $240 minimum fee for temporary service.

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
SERVICE INFORMATION
Check One: Type
Overhead Underground
Check One: Size
SIZE 100A 200A 400A Other
Check One: Phases

1 Phase 3 Phase
Service Conductor Wire Size:
Number of Conductors Per Phase:
Closest Grid / Pole Number:

10 digit number on the pole (5 digits and a break and 5 digits)
Date service is requested:

Other Information:

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