New Construction Form

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Step 1: To initiate installation of electric service to a service location that is not currently receiving electric service, complete the form below and submit.

Step 2: You will be contacted by a Co-op representative to provide any additional information needed to process your request, or to schedule an appointment to view the site for the proposed electric service installation. When you meet with a Co-op representative to view the site for proposed electric service, please bring with you a copy of your deed, a copy of that portion of the town tax map showing your lot, and the names and addresses of all abutting or affected property owners.

Step 3: Upon approval of this application and receipt of all applicable paperwork, you will be asked to sign this contract (or a revised contract) to authorize installation of the electric service.

Questions? Call 1-800-698-2007 or email us.

Fields marked with an asterisk (*) are required.

*First Name

Middle Name

*Last Name

*Current Mailing Address

*City

*State

*Zip

*Service Property Address

*City

*State

*Zip

*Email Address

Other Applicants

*First Name

Middle Name

*Last Name

This is Primarily a Residence

This is Primarily a Business

Other

Applicant is the Property Owner

Owner's Name

Owner's Phone

(Including area code)

Daytime Phone

Upon installation, how long do you expect to occupy this location?

NOTE: Please enter all dates as mm/dd/yyyy

Date you want the electric service installed

Have you previously received electric service from the cooperative?	Yes
	No

If YES, in what town

When did you stop receiving this service?

Is there an electric water heater in use at the location?	Yes
	No

Is there permanently installed electric space heating in use at the location?	Yes
	No

Is this the first contact you have made with the Co-op regarding this job?	Yes
	No

I/We hereby apply for membership in the New Hampshire Electric Cooperative, Inc., and for electric service to be supplied at the address herein described. I/We agree to pay for the service therefore subject to Rates, Terms and Conditions of the New Hampshire Electric Cooperative, Inc., as filed with the Public Utilities Commission and in effect at the time of delivery or as subsequently revised. I/We have noted the minimum term of service specified in the applicable rate and understand that should service be requested to be terminated within such minimum term of service that I/We shall pay such amounts required to fulfill the minimum term of service requirements. I/We further understand that should the service herein requested involve a so-called line extension as defined within the terms and conditions of the tariff of the New Hampshire Electric Cooperative, Inc., that I/We shall enter into a contract for the required minimums for the required period with the New Hampshire Electric Cooperative, Inc., such contract to be of such a form as used by the Cooperative. I/We shall reimburse the Cooperative for all fees associated with the recording of necessary easements. In signing this application, I/We hereby agree to the extending and maintenance of utilities within the boundaries of my/our property. I/We recognize that the Cooperative has a right to construct, repair, operate, maintain, patrol, replace and remove overhead and underground lines consisting of wires, ducts, cables, poles and other apparatus necessary for the transmission and distribution of electricity over and under my/our land in New Hampshire. This includes any necessary cutting and trimming of vegetation 15 feet on either side of the electric lines. Planting of trees, building of structures or storage of lumber and/or other materials within this right-of-way shall not be undertaken without the knowledge and consent of the Cooperative. I/We will not hinder or obstruct the installation or reliability of services to other members of the Cooperative. As a member of the Cooperative I/We agree to be bound by its Charter and Bylaws.

You will be required to sign this (or a revised) contract upon receipt/approval by the Co-Op of all related paperwork prior to installation of electric service. Submitting this form does not complete the process.

Submission Verification *

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