Construction Form

Congratulations on your new property and welcome to Midwest Energy and Communications.

Please read and complete all sections on this form. We cannot move forward until all items are received.

Once we process the completed form, we will call you to schedule an appointment for a Line Design Technician to visit your property. Following that appointment, you will receive an invoice. If you are attending the appointment, we will bring your Right-Of-Way Easement form as well. If your contractor will attend the meeting on your behalf, we will send the easement with your invoice. Please note: your invoice needs to be paid and the easement needs to be returned to our office prior to the start of construction.

We look forward to being your energy partner.

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Step 1. Application for Service

The undersigned hereby applies for electric service from MIDWEST ENERGY & COMMUNICATIONS (MEC) and in consideration of the acceptance of this application agrees with MEC on the following:

As soon as electric energy is available, the undersigned will purchase monthly electric service from MEC not less than the monthly service charge, which shall be determined by the Board of Directors of MEC, and will pay for all additional electric energy used by the undersigned for not less than twelve consecutive months following connection at the price approved by the Board of Directors.
The undersigned will grant to MEC, at its request, the necessary rights, privileges, easements and necessary tree work to construct, operate, replace, repair and perpetually maintain equipment on the property owned or occupied by the undersigned and in or upon all roads, streets or highways abutting said property or the line or lines for the transmission or distribution of electric energy. The undersigned will execute and deliver to MEC any conveyance, grant or instruments which MEC shall deem necessary or convenient for said purposes. All service lines supplying the undersigned with electric energy and all switches, motors and other appliance and equipment constructed or installed by MEC on said property, shall be the sole property of MEC, and MEC shall have the right to access said property to repair and service, and upon the discontinuance of service for any reason, to remove the same. MEC shall not be liable for any damage to any un-located member-owned facilities during the installation of electric service.
The undersigned shall have all the rights and privileges granted to members under the Articles of Incorporation and By-Laws of MEC or any amendments thereto and will comply with and be bound by such Articles of Incorporation and By-Laws and all rules and regulations as may be adopted by the Board of Directors of MEC.
The acceptance of this application by MEC shall constitute an agreement between MEC and the undersigned upon the terms hereinabove set forth.

Accept the Application for Service by initialing here ^*

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Step 2. Hold Harmless Agreement

MEC is committed to completing your project in a timely and professional manner. However, member-owned underground facilities are not marked or protected by Miss Dig, so we must have the signed Hold Harmless Agreement before we proceed. Also, despite our most diligent efforts, ruts or other cosmetic property damage may result as we move vehicles or equipment onto your property. The agreement is limited to the service location and expires upon completion of this project or removal of facilities.

I agree that MEC is not responsible for damage to any unmarked, member-owned underground facilities as it relates to work at the service location. This includes secondary electric, water, phone, gas, septic, well head and any other underground facilities. I further agree that MEC is not responsible for yard or property damage incurred as a result of accessing property for this project.

Accept the Hold Harmless Agreement by initialing here ^*

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Step 3. Contact Authorization

In order to provide timely and effective communication, we need your primary phone number and ask that you authorize us to use that number to deliver important account-related information.

I hereby authorize MEC to deliver planned outage notifications, delinquent account/disconnect notices, billing notices, right-of-way tree-clearing notifications using an automatic telephone system, artificial or prerecorded voice, text message or other form of written or audible communication via the phone number provided in this form.

Contact Information

Name ^*

First Name

Last Name

Primary Phone ^*

Email Address ^*

Mailing Address

Mailing Address ^*

Street Address 1

Street Address 2

City ^*

State ^*

Zip Code ^*

Service Address

Same as Billing Address

Service Address ^*

Street Address 1

Street Address 2

City ^*

State ^*

Zip Code ^*

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Step 4. Site Sketch

Use your mouse to draw your building site.

Show location of ALL facilities (septic, water, gas, cable, etc.), nearest pole #, driveway and location of meter base.

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Step 5. Site Information

* Required: if unsure please place N/A in the answer.

Deeded Property Owner (s) ^*

Parcel # ^*

Contractor ^*

Building Site Address ^*

Building Site City ^*

Will electric service be (please check one) ^*

Overhead

Underground

Are you building in a subdivision? (please check one) ^*

Yes

When will construction begin? ^*

Will you need temporary service during the construction process? (please check one) ^*

Yes

What is your contractor’s phone number?

Applicant Signature ^*

Please go back through the steps and make sure you have completed all the required fields.

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