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New Service/Upgrades New Service Application

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First Name*

Last Name*

Current Mailing Address*

Current City*

Current State*

Current Zip Code*

New Service Address

City*

State*

Zip Code

Email Address*

Phone Number*

Building Contractor*

Contractor Phone Number

Are you currently a member?

Yes

No

Pioneer Account Number

Temporary Service Requested?

Yes

No

Construction Date

MM slash DD slash YYYY

County

Township

Driveway In?

Yes

No

House Staked?

Yes

No

Type of Residence

Framed (Stick Built)

Modular

Mobile

Must be approved by the county before setting up an appointment:

Location of Well

Septic

Leach Field

Square Feet of Floor Space

Air Conditioning

Central Air

Other

None

Water Heater

Electric

Natural Gas

Propane

Other

Type of Heating

Electric

Natural Gas

Propane

Geothermal

Oil

Other

Additional Notes or Comments

About Us

Our Locations

344 West U.S. Route 36
Piqua, Ohio 45356

767 Three Mile Road
Urbana, Ohio 43078

Our Hours

Monday-Friday: 8am-4pm
Saturday-Sunday: Closed

Emergency service is always
available by calling 800.762.0997

Thanks to our Energy Partners:

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