New Service Form

Before You Begin

Address and/or lot number shall be clearly posted at property.
Gas riser/meter bracket and/or electric meter socket shall be installed where applicable.
Meter site ground shall be backfilled and properly compacted to prevent settling.
Ground shall be within 4” of final grade where the gas/electric facilities are to be installed.
All material and obstructions shall be removed from the route/area where the gas/electric facilities are to be installed.
Privately owned underground facilities and systems shall be located and marked.
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You will receive a confirmation email when the order is scheduled. The email will include any access requirements, order date and other important information. Please read the confirmation carefully.

General Information

New or Existing Building

New

Existing

Building Type

Residential

Commercial

Residence Type

Sub Division

Lot Number

Map Location

Please enter an address, starting with Zip Code. Then, click "Search" and select the exact location on the map.

Zip Code

State

City/County

Street

House Number

House Number Prefix Street Name Street Suffix Suffix Unit
Delete: House Number: Prefix: Street Name: Street Suffix: Suffix: Unit: Service Type: Gas Permanent Electric Temporary Electric Volts: Amps: Phases:

I have verified the address is correct.

Billing Information

Will this be billed to an individual or company?

Individual

Company

Please enter the account phone number and the last four digits of the SSN/TIN.

Phone Number

Last 4 Digits SSN/TIN

Customer

Name

Phone Number

Mailing Address

City

State

ZIP Code

Requestor Information

Name

Phone Number

Date

Gas Information

Same as Requestor Information

Plumbing Contractor Name

Phone Number

Delivery Pressure

Max Pressure

BTU Load

Bracket Location

Gas Use

How Many?

Gas Use

How Many?

Heating:

Water Heating:

Fireplace:

Cooking:

Generator:

Process:

Other:

Description

Electric Information

Same as Requestor Information

Contractor Name

Phone Number

Permanent Electric

Installation Type

MEC Installed

Customer Installed

Location

Main Heat Source

Water Heat Source

Solar

Yes

Do you need to have temporary electric service removed?

Description

Temporary Electric

Date Needed

Location

Transformer Needed

Yes

Description

Acknowledgement

Terms and Conditions

By submitting your application, you request and authorize MidAmerican Energy to install and/or repair gas and/or electric facilities on your property listed above. Service installation by customer/electrician is subject to applicable income tax gross-up charges. Applicant shall locate and mark all privately owned underground facilities and systems (including but not limited to septic lines, water lines, sprinkler systems, electric wires, fuel lines, etc.) to conform with the current version of Recommended Guidelines for Underground Utilities and the uniform color code established by the American Public Works Association, prior to MidAmerican Energy's construction. MidAmerican Energy will not be responsible for damage to customer-owned underground facilities if the facilities are not properly marked on the property. Service shall be subject to all of MidAmerican Energy's applicable tariff schedules, electric/gas service manual, and applicable codes, rules and regulations on file with and authorized by the appropriate state utilities board/commission.

I acknowledge the information submitted in this form is accurate and I agree to the Terms and Conditions above.