Rebuild Form

Applicant Information

Enter your Account #

First Name

Last Name

Phone

Record Type Name

Service Address Information

Street

City

State Abbreviation

Zip Code

Is mailing address different than service address?

Mailing Address

Street

City

State Abbreviation

Zip Code

Type of Building Project

Type of Building Project

Other project type

Please describe in full the changes to be made on your electric service:

Meter Information

Meter Location

Underground to BuildingOverhead to BuildingUnderground Post or Pedestal

What side of the building is the meter socket located?

NorthSouthEastWestN/AOther...

Meter socket other location

Service Details

Service Size

200 amp320 amp400 amp600 ampOther....

Other service size

Which of the following appliances/utilities are electric?

Water heaterPrimary heatSecondary heatClothes dryerCentral air conditioningWindow air conditioningKitchen stoveShop welderOther larger appliances (electric)

Other electric appliances

Who is doing the electrical work?

Contractor Phone Number

Would you like to meet with the Polk-Burnett engineering technician on site?

YesNo

Upload Site Design

Optional: Upload document with site design. Please include any of the following:

Lot dimensions
Location of building relative to street
Desired location of meter
Septic and drain field
Future buildings
Any other pertinent information related to your project.

Optional upload

Electronic Acknowledgement

Type First and Last Name

Today's Date

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