New Commercial Building – Electric Questionnaire Step 1 of 3 0% This application is for service in our co-op territory only - Union County, OH, and the immediate vicinity.Member Information** NOTE TO APPLICANT: If your deed information is not available at this time, you may submit your application to begin the new service process. HOWEVER, this information MUST be submitted to URE and an easement created and signed by the property owner(s) BEFORE any URE facilities will be installed.**(Required) I AGREE to provide all necessary documents Please Select(Required) Sole Proprietorship Partnership Corporation Name(Required) First Last Service Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mailing Address(Required) Same as Service Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Tax ID Number(Required) Are you the owner of this business?(Required) Yes No Property Owner Name(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Builder/Contractor InformationBuilder/Contractor Name(Required) Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Service TypePermanent Service Desired Date (mm/dd/yyyy)(Required) Month Day Year Service Type Needed(Required) Electric Gas Both Electric Load InformationMain Panel Service Size Amps Volts Please Select Single Phase Three Phase Service Conductor Size Number of Conductors Type Copper Aluminum Building Square Footage Temp Service Size Required - Amps Phase Lighting & OutletsNew Kilowatt (kW) Load Existing kW Load Air ConditioningNew kW Load Existing kW Load HeatingNew kW Load Existing kW Load Water HeatingNew kW Load Existing kW Load MotorsNew kW Load Existing kW Load Dry Type TransformersNew kW Load Existing kW Load OtherNew kW Load Existing kW Load Back Up GeneratorkW Fuel Source Motor Load DetailsAll Motors Over 5 Horsepower(Click the + button to add a new row)SizeVoltage1-Phase Fla3 Phase FlaType of Start Add RemoveMiscellaneous EquipmentAll Loads Over 5 kW(Click the + button to add a new row)DescriptionVoltagekW1 Phase Fla3 Phase Fla Add RemoveGas Load InformationGas Service to be Used for: Space Heaters Water Heating Food Prep Manufacturing Other List other Gas services used: Total Load Given in Standard Cubic Feet per Hour (SCFH) or Total Load Given in BTUH Total Load Given in Standard Cubic Feet per Hour (SCFH) or Total Load Given in Standard Cubic Feet per Hour (SCFH) or Delivery Pressure Required Appliance or Gas Burning Equipment Information(Click the + button to add a new row)Number of UnitsUsage (SCFH)Equipment TypeBTU Input Rating Add Remove Load Forms or Construction Plans Drop files here or Select files Max. file size: 512 MB. Things to Provide or Do Before Site Meeting Complete a member application (if not already a member) for electric/natural gas service. This application must be signed and returned to URE. Review the New Commercial Construction Questionnaire. Be prepared to provide the information to the URE Engineer. You may submit the completed form prior to the meeting or complete it during the meeting. Submit a complete set of final state/county-approved site plans with service entrance and meter locations marked. URE needs one set of plans to be submitted in PDF format and one set of plans to be submitted in Auto-CAD. Provide a copy of the written legal description of the site and property as well as the survey map. Stake building corners and lot lines. Member Signature & ConsentMember Consent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.The undersigned (hereafter called Applicant) hereby apply for membership in the Union Rural Electric Cooperative, Inc. and/or its subsidiary or affiliated companies (hereafter known as Cooperative) and agrees to be bound by the Cooperative’s Terms and Conditions for Supplying Electric Service and Terms and Conditions for Supplying Natural Gas Service and the following: Applicant will pay for all services at prices set by the Cooperative for services on or before the due date specified on the Applicant’s bill. Failure to do so may result in the Applicant being charged late payment penalties or result in discontinuance of service. Re-establishment of the Applicant’s service may require that all unpaid balances be paid in full along with a security deposit and other fees. Applicant designates the Cooperative as the Applicant’s agent for the purpose of entering into third party agreements to secure electric and/or natural gas supply, transmission and distribution services. Applicant agrees to be bound to and comply with the Code of Regulations and Articles of Incorporation as set and revised by the Cooperative Board of Trustees. Applicant agrees to maintain and properly use customer owned facilities and any apparatus connected to the Cooperative’s system, and agrees to identify and hold harmless the Cooperative against any injury, loss, or damage as a result of the use or misuse of customer’s facilities or apparatus. In no event shall the responsibility of the Cooperative extend beyond the point at which its service facilities are attached to the customer structure(s) on the premises to be served by the Cooperative. Applicant grants to the Cooperative the right to enter upon and an easement on, over, across, under and through any part of the premises to be served by the Cooperative to construct, install, operate, reconstruct, rephase, relocate, maintain, repair, and remove any part of the Cooperative facilities and/or communication systems for the purpose of providing all services applied for and to do all things incident or necessary thereto, including without limitation cutting, removal and controlling the growth of the vegetation that may interfere with or threaten to endanger the operation and maintenance of said system. Natural gas Applicants hereby acknowledge receipt of Terms and Conditions for Supplying Natural Gas Service As part of your cooperative membership, you will receive a subscription to Ohio Cooperative Living magazine. Applicant acknowledges and agrees that the Cooperative may review the Applicant’s credit history as a result of this application. Member Electronic Signature (Full Name)(Required) NameThis field is for validation purposes and should be left unchanged.
