Application for Temporary Service

You must complete all fields of this form if you are building a new, or renovating an existing residential, commercial, or industrial building and require a temporary service.

Requested Service Date:  20

Service Located at: 

Service Type: 

Anticipated Load: 

Business Type: 

Phone #: 

Billing Name: 

Mailing Address (if different): 

Taxpayer ID #: 

Sales Exempt Organization:  No   Yes, must attach completed NYS Form ST-121  
Email Address: 
                               Check to Receive E-Bill Only