National Grid
Electric & Gas Service This form is used for:
  • New electric and gas service (for contractors or someone who is building their home)
  • Upgrade or relocation of electric and gas service
For help completing this form, please review Electric & Gas Service Additional Information or our Steps for Service.

  (Required Information = required information)
General Information
Required InformationIs this for residential or commercial service?
Customer Information
Required InformationContact Name:
Required InformationContact Phone: ()-
Required InformationEmail Address:
Note: Contractors do not need to fill in the customer email address.
Required InformationCustomer/Business Name (for billing):
Required InformationDoes 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
Required InformationContractor Name:
Address:
City:
State:     Zip Code:
Required InformationContact Name:
Required InformationTelephone: ()-
Fax Number: ()-
Email Address:
Building/Structure Information
Required InformationDate Service Requested: / /
(8 weeks lead time required.)
Required InformationService Address:
Lot Number (if applicable)
Address 2:
Required InformationCity:
State:     Zip Code:
Service Phone: ()-
Lot/Loc Staked?
Date Foundation Completed: / /
Required InformationIs the structure framed or completed?
 
*If no, date when to be framed or delivered.
 
        / /
Required InformationBuilding type:
Required InformationPoint of attachment:
Electric Service Information
Required InformationNumber 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)
 
Required InformationService Type:
Required InformationVoltage:
Required InformationAmperage:
Required InformationPhases:
Required InformationNo. of Wires:
Required InformationLoad kW:
Gas Service Information
Required InformationNumber of Gas 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)
 
Required InformationTotal Proposed Load:(CFH or BTU?)
 
Required InformationAppliances/units to be connected:
  Hold down <Ctrl> key to make multiple selections

Other (Specify):
Service to install:
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
Required InformationClosest Intersection:
Development Name:
Additional Comments
Comments: