Residential Sign-On Card Sterling Municipal Light Department 5 Electric 5 Residential Electric 5 Residential Sign-On Card "*" indicates required fields Contractor InformationContractor Contact Name* First Name Last Name Business Name**Business PhoneBusiness Address Street Address City 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 State ZIP Code Customer InformationCustomer Name*Customer PhoneCustomer Address Street Address City 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 State ZIP Code Service Address (Lot No.)Description of ServiceType of BuildingResidentialCommercialIndustrialMain SwitchAmpsVoltsPhaseService DescriptionOverheadUndergroundType of ServiceNewUpgradeRemoveTempBuilding StatusNewExistingAdditionTotal # of MetersSquare footage of buildingWill there be on site generation?YesNoDistance of building to streetDescription of WorkSite Plan Upload Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, rtf, doc, docx, Max. file size: 25 MB, Max. files: 3. ATTACH A SITE PLAN IF AVAILABLE. INCLUDE: ROADS, SIDEWALKS, DRIVEWAYS, HYDRANTS, EASEMENTS, ETCAuthorizationBy the signature affixed below, the SMLD, its Employees or Agents are hereby released of any damages resulting from electrically energizing service. It is further agreed that: 1.) All electrical URD service wiring will be done in accordance with the SMLD Underground Distribution Standards and Specifications. 2).All electrical wiring will confirm to the Standards of the Nation Electric Code. 3). All wiring will be inspected by an Electrical Inspector. 4).That the SMLD through its Agents or Employees may inspect the wiring of this property at any time. The customer below hereby applies for electrical service and agrees to promptly pay all bills rendered for electric service. Must provide no less than three day notice to the SMLD to discontinue such service and further agrees to be bound by the SMLD's terms and conditions so called as they may exist from time to time.Signature*Date*
