National Grid
Work Request Form Use this form to request a new or temporary service, or to change an existing service. All service work must comply with the Electric Service Information and Requirements (The "Green Book") (pdf). A Work Request Number will be emailed within two business days.

  (Required Information = required information)
General Information
Order Type:
Is this for residential or commercial service?
Customer Information
Customer Name:
Telephone: ()-
Email Address:
Note: Contractors do not need to fill in the customer email address.
Customer/Business Name (for billing):
Does this customer (or business) currently or previously have service with us?
 
*If Yes, please provide the account number, and continue at the Contractor Information section below.
 
       Account Number:
 
**If No, please complete the rest of this section.
Customer/Business Mailing Address:
Address 2:
City:
State:     Zip Code:
Employer:
Social Security No. or Taxpayer Id:
Spouse's Name:
Type of Business:
Contractor Information
Contractor Name:
Address:
City:
State:     Zip Code:
Contact Name:
Telephone: ()-
Fax Number: ()-
Email Address:
Building/Structure Information
Date Service Requested: / /
(8 weeks lead time required.)
Service Address:
Lot Number (if applicable)
Address 2:
City:
State:     Zip Code:
Service Phone: ()-
Lot/Loc Staked?
Date Foundation Completed: / /
Is the structure framed or completed?
 
*If no, date when to be framed or delivered.
 
        / /
Building type:
Point of attachment:
Electric Service Information
Number of Electric Meters:
 
* If more than one meter, indicate the instructions for designating the meters (i.e., 1 house meter and 6 apartment meters labeled Apt 1 - Apt 6)
 
Service Type:
Voltage:
Amperage:
Phases:
No. of Wires:
Load kWh:
Life Sustaining Equipment
Will there be any of the following electrically-operated life-sustaining medical devices in use at this address?
Apnea Monitor:
Home Kidney Dialysis Machine:
Continuous Ventilation Device:
Suction (Aspiration) Machine:
Other:   
Directions to Property
Closest Intersection:
Development Name:
Additional Comments
Comments: