Form Center

2. Note:

   Please make sure you have sufficient time for completion as this form will not save progress for use at a later time. 

   Upon submission, it will be e-mailed to the utility shop office personnel, including the master electrician. 

   Please call 763-576-2903 with any questions.

4. Appointment Confirmation Preference*

   1. Email
   2. Phone Call
6. Customer First Name*

   Name on application.

7. Customer Last Name*
9. Service Address*
11. City
12. State
13. Zip Code
15. Is the location of project installation the same as the Service Address?*

    1. Yes
    2. No
17. Installation Location Address:

    (if different from Service Address above)

    Single location only. Do NOT include multiple locations please.

19. Is the customer the person attending this meeting?*

    1. Yes
    2. No, there will be someone else attending this meeting.
21. Name of Person Attending*

    Add description if applicable (ex. Electrician).

23. Please select three dates for potential disconnection appointment times.

    NOTE:

    1. Dates should be in order of preference from first to last choice.

    2. Select any date/time span from 8 a.m. to 2 p.m. Monday through Friday.  
         (Regular Business Days only, no holidays or weekends)

25. Date and time span - First Choice*
    Date and time span - First Choice Start Date

    Date and time span - First Choice Start Time

    —

    Date and time span - First Choice End Date

    Date and time span - First Choice End Time
27. Date and time span - Second Choice
    Date and time span - Second Choice Start Date

    Date and time span - Second Choice Start Time

    —

    Date and time span - Second Choice End Date

    Date and time span - Second Choice End Time
29. Date and time span - Last Choice
    Date and time span - Last Choice Start Date

    Date and time span - Last Choice Start Time

    —

    Date and time span - Last Choice End Date

    Date and time span - Last Choice End Time
31. Comments?

    Anything you would like us to know regarding your appointment request.

33. Next Step:

    We will be in touch as soon as possible to confirm an appointment date and time. 

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field