1General Info2Similar Account Info3Service Type & Characteristics4Electric Load5Operation Time & Location FacebookThis field is for validation purposes and should be left unchanged.Service LocationAddress(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Type of Business(Required)Electrician InfoElectrician Name(Required)Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Electrician Phone Number(Required)Electrician Email Member InfoMember Name(Required) First Last Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Member Email(Required) Facility InfoTotal Square Footage(Required)Conditioned Space Square Footage(Required)Type of Heat(Required) Similar Account Information(Buildings of like types of business, square footages, operating hours, and heating type)Name of Similar BusinessAddress Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Similar Business Account Number(s) Type of ServiceHeat Type(Check all that apply) Heat Pump Electric Heat (Baseboard or Furnace) Strip or Emergency Heat Service CharacteristicsSets of Load Wires Per Phase(Required)Load Wire Size(Required) 4 2 1/0 2/0 4/0 350 MCM 500 MCM 750 MCM 1000 MCM Other Load Wire Type(Required) AL CU Terminations(Required) Meterbox C.T. Cabinet Connection Box Other Service SizeServices(Required) 200 amp 320 amp 400 amp 600 amp Other VoltageSelect 1:(Required) 1 Phase 240/120 3 Phase Wye 208/120 3 Phase Wye 480/277 3 Phase Delta 240/120 (high leg) Electric Load (Excluding Motor Load)For sections not applicable to your project please fill with N/A.Interior Lighting (kW)Exterior Lighting (kW)Electric Cooking (kW)Water Heating (kW)Dryer (kW)Computers (kW)Receptacles (kW)Refrigeration (kW)OtherHeat Type Heat Pump Electric Heat (Baseboard of Furnace) Strip or Emergency Heat Other Running KilowattsAmperage (LRA)AC (Data Processing Load Only, in Tons)AC (Not Including Data Processing, in Tons)Electric Motor Load (Except Heating & AC)Load 1:Phase Single Phase 3 Phase Number of MotorsHP per MotorVoltageHours of Operation Per WeekLoad 2:Phase Single Phase 3 Phase Number of MotorsHP per MotorVoltageHours of Operation Per WeekLoad 3:Phase Single Phase 3 Phase Number of MotorsHP per MotorVoltageHours of Operation Per WeekLoad 4:Phase Single Phase 3 Phase Number of MotorsHP per MotorVoltageHours of Operation Per WeekLoad 5:Phase Single Phase 3 Phase Number of MotorsHP per MotorVoltageHours of Operation Per WeekLoad 6:Phase Single Phase 3 Phase Number of MotorsHP per MotorVoltageHours of Operation Per WeekLoad 7:Phase Single Phase 3 Phase Number of MotorsHP per MotorVoltageHours of Operation Per Week Estimated Business Operation TimeHours Per WeekMonths Per YearMeter & Service Equipment LocationDesired Meter LocationDesired Service Equipment LocationIf you have more load information to submit, please send the additional information to engineering@anec.com.SignatureConsent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Electronic Signature (Full Name)(Required)The information provided in this document, by the customer, is critical to A&N Electric Cooperative in sizing our electrical facilities to provide reliable service to you. This information will also be used to determine the installation cost for electrical service. *A&N Electric Cooperative reserves the right to designate and/or approve the location of all metering and C.T. equipment. The company must approve all proposed metering arrangements. **The member must notify A&N Electric Cooperative prior to the actual connection of any future load.
