Rocky Rural Electrification Association

New Connection Form

Application to Connect a service in Rocky R.E.A. Ltd. service area
Connection Form
	NAME (first and last):
	ADDRESS:
	Requested connection date:	Day	Month	Year
LAND LOCATION Quarter-- Section-- Township-- Range-- Meridian--
Plan Block Lot Parcel size acres
	Are you the OWNER?---- check box if you are	Are you the RENTER?-----check box if you are
		Landlord's Name ------ Landlord's phone #----
	Home Phone #:: Office Phone #: Cell Phone #:	E-MAIL ADDRESS : Fax #:
	COMMENTS:
	*Note: If Renter (Tenant) we require a $500.00 deposit to be paid at the office before service can be provided.