I am the(Required) Property Owner Other Member InformationName of Applicant(Required) First Last Name of Spouse First Last Billing/Mailing 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 Applicant Email Address(Required) Alternate Email Address Primary Phone Number(Required)Alternate Phone NumberLatitude/Longitude(Required) Contractor InformationName of Contractor Contractor Phone NumberContractor Email Address Location of ServiceAddress of Service(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 Parcel Number(Required) Subdivision Lot Number Anticipated Date for Permanent Service (mm/dd/yyyy)(Required) Month Day Year Tax District(Required) Building Permit Number(Required) Service InformationType of Service(Required)Check all that apply Single Phase Three Phase Overhead Underground Water Duration of Service(Required) Temporary Temporary to Permanent Permanent Size of Service(Required) 100 AMP 200 AMP 320 AMP Other Water Service Size(Required) ¾ inch 1 inch 1½ inch 2 inch 3 inch 4 inch 6 inch or larger Livable Square Footage(Required) Service Will Be To(Required) Site Built Home Mobile/Manufactured Home RV/5th Wheel Garage, Shop, or Barn Business Security Light Well Horsepower of Pump Motor(Required) Voltage of Pump Motor(Required) Estimated Gallons per Minute(Required) CommentsNew Service Plot PlanPlease download and complete the New Service Plot Plan (PDF) and upload a completed copy to this application.Upload Completed New Service Plot Plan(Required) Drop files here or Select files Max. file size: 300 MB. AgreementAgreement to Accept Service(Required) I hereby apply for electrical/water service at the above location. I understand that GCEC willl make service available upon completion of engineering details, any contractual agreements between parties, construction of facilities required to provide service and subject to the cooperative's policies and charges.Applicant Electronic Signature (Full Name)(Required) NameThis field is for validation purposes and should be left unchanged.
