Electrical Data Form

Property Owner's Information:

Customer Name:

Electric Service Address:

Town:

Zip Code:

Customer Primary Phone #:

Customer Cell Phone #:

Customer Email Address:

Is an Appointment for Site Meeting Needed? Yes No

Customer's Mailing Address:

Is the customer's mailing address the same as the service address? Yes No

Electrical Contractor's Information:

Business Name:

Electrician/Contractor Name:

Address:

Town:

Zip Code:

Office/Primary Phone #:

Cell Phone #:

Fax #:

Email Address:

License #:

Job Details:

Description of Job:

Date Desired:

What type of property is this? Residential Commercial Industrial

Existing Meter #:

Customer's Central Hudson Account #:

Job Type: New Service Upgrade Relocate Repair Retire Disconnect/Reconnect

Total Meters:

Total Square Feet:

Total Connected kW:

Demand kW:

***If total kW is more than 100 kW, a Load Letter is required. Please submit Load Letter with application.***

Load Letter File Upload (only required if total kW exceeds 100 kW):

Is CT Metering Required? Yes (True 400A or more) No (320A or less)

Nearest Central Hudson ...

Pole #:

Splice Box #:

Pad #:

Is Foundation Already Installed: Yes No

Date Structure Completed:

Distance to Structure From the Road:

Do You Want Natural Gas Service (if available)? Yes No

Nearest Intersecting Road:

Directions to Property:

Additional Comments:

Payments

Billing

Manage My Account

Save Money

Save Energy

Assistance Programs

Support

Forms

Working With Us

Outages

Storms

Safety

Electrical Data Form

Property Owner's Information:

Customer's Mailing Address:

Electrical Contractor's Information:

Job Details: