Service For New Structure Sign-Up Form

New Structure Sign-up Form

Please note: A Utility Authorization Number (UAN) is required

by your licensed electrician in order to complete this process.

Electric service is requested for:
Town:	Reading Lynnfield North Reading Wilmington
Meter/Service address:

Customer name:
	Permanent orTemporary (requires $300 fee)
Please refer to Terms and Conditions for construction service requirements.

Contact person for this account:
SSN or MA driver's license number*:
*This information is not required if the customer is a builder or property management company.

Day phone number:
This is the number we will use to call you today, if we have any questions.
Your e-mail address:

Billing address (if different from service address):
Street:
City:
State:
Zip:

Where can we send your Customer Application for signature? This needs to be signed, dated, and returned.
	Service address Billing address:
Street:
City:
State:
Zip:

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