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Application for Temporary and Underground Service

 

Please submit this form to apply for service with Brunswick Electric.  You will receive a confirmation message after submission.  Then, within one business day you will also receive an email or telephone call from our customer service group to arrange payment of the required fees and complete processing of your request for service.

 

 

Please provide at least one phone number - home, work or mobile. Providing a phone number authorizes BEMC to use the number in efforts to make contact for business purposes.
BUSINESS INFO
If request is for a business, please fill in this section.
SERVICE ADDRESS
Address where service is to be installed.
physical address, city, state, zip
SERVICE DESCRIPTION
List any other facilities in place on the site (cable, tel, etc.)
It is the customer's responsibility to locate and mark these other facilities.
Describe physical location of the T-pole (temporary pole) or meter pan location on the building, relative to the street.
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