Electrical Service Request Form

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Electrical Service Request

Date : 5/28/2022

I. Requestor: (Party who will provide project information and updates to Hawaiian Electric Company)

A. Company Name:
Company Name
B. Requestor Name:
First Name
Last Name
Street #
Street Name
Unit / Apt. #
City
State
Zipcode
C. Contact Information:
Phone	Ext.
Type
Other
Alt. Phone	Ext.
Type
Other
Email
D. Requestor Is:
Requestor is
Other

II. PROJECT INFORMATION:

A. Project Name:
Project Name
B. Project Address / Location:
Island Region
Street #
Street Name
Unit / Apt. #
City
State
Zipcode
Gate Code
C. Building Permit #:
Building Permit #
Option Selected
D. Property Information:
Tax Map Key Number
Lot #
E. Customer / Owner Name:
First Name
Last Name
Meter #
Are you an existing customer?
Account #
Phone	Ext.
Type
Other
Email
Last $ #
F. Consultant / Licensed Contractor:
Licensed Electrician
Licensed Electrician Phone	Ext.
Architect
Other
G. Type of Request:
Type of Request
Request Details
Permanent Service Details
Existing Service Details
Customer Interconnection Tool ID#
H. Type of Project:
Type of Project
Multi-Family Details
I. Type of Service:
A.
B.
C.
J. Voltage:
A.
B.
C.
D.

III. ALTERNATE POWER:

A. Indicate if other / future source of power will be utilized or is being considered:
Indicate if other / future source of power will be utilized or is being considered:

IV. Consultant Requests Only: (Complete this section)

A. Load / Generation:
Total Connected (KVA)
Total Demand (KVA)
Total Generation (KW)
Load will consist of: (select all applicable)
Other
B. Building:
Total Square Footage (Sq Ft)
Square Footage w/ AC (Sq Ft)
C. Equipment:
Equipment Type	Rating (HP/KW) #Units Total Load (rating x #units)



D. Services Needed & Need by Date:

V. Billing Information: Energy Usage (Party responsible for energy usage after meter is installed)

A. Name to Appear on Bill:
First Name
Middle Name
Last Name
Name of Business
Are you an existing customer?
Account #
B. Billing Contact Information:
Phone	Ext.
Type
Other
Alt. Phone	Ext.
Type
Other
Email
C. Billing Address:
Street #
Street Name
Unit / Apt. #
City
State
Zipcode
D. Responsible Party Is:
Responsible Party Is
Other
E. For New Residential Customers:
Occupation of party responsible for bill
Employer
Years employed
Spouse's Name
F. For New Commercial Customers:
Type of business
Number of years in business
Tax ID no.
Hawaii General Excise Tax No.
New Commercial Customer Type
New Commercial Customer Other

VI. Billing Information: Construction Cost (Party responsible for construction costs)

A. Name to Appear on Bill:
First Name
Last Name
Name of Business
Are you an existing customer?
Account #
B. Billing Contact Information:
Phone	Ext.
Type
Other
Alt. Phone	Ext.
Type
Other
Email
C. Billing Address:
Street #
Street Name
Unit / Apt. #
City
State
Zipcode
D. Responsible Party Is:
Responsible Party Is
Other
E. For New Residential Customers:
Occupation of party responsible for bill
Employer
Years employed
Spouse's Name
F. For New Commercial Customers:
Type of business
Number of years in business
Tax ID no.
Hawaii General Excise Tax No.
New Commercial Customer Type
New Commercial Customer Other

VII. Submittals: (Items that are being submitted to Hawaiian Electric Company)

A. Select All Items to be Submitted:
Select All Items to be Submitted
Other
B. Type of Drawings:
Type of Drawings
Other
C. Drawings will be Sent Via:
Drawings will be Sent Via
Other

VIII. Remarks: Please provide additional information that will help us complete your request.

Remarks
Remarks

Security Check

Please review these requirements before submitting your request:

I. Project Manager: (Party who will manage this project and provide information, updates, and/or is the point of contact for this project)

A. Company Name: (Indicate Company Name if you are a consultant, contractor, electrician, or architect.)

B. Requestor Name:

C. Contact Information:

D. Requestor Is: (Select one)

II. Project Information:

A. Project Name: (Project name should be Last Name, First Name or Company Name.)

B. Project Address / Location:

C. Building Permit #: (Additional costs may apply for service requests without permits)

D. Property Information:

E. Owner Name:

Are you an existing customer?

F. Consultant / Licensed Contractor: (First, Middle Initial, Last)

G. Type of Request: (Select one)

New Service (Select one)

Existing Service (Select one)

Other Services (Select one)

H. Type of Project: (Select one)

I. Type of Service: (Complete A-C)

A.

B.

C.

J. Voltage: (Complete A-C. Complete D if applicable)

A.

B.

C.

D.

III. Alternate Power:

A. Indicate if other / future source of power will be utilized or is being considered:

IV. Consultant Requests Only: (Complete this section)

A. Load / Generation: (Provide load or generation information.)

B. Building: (Provide square footage.)

C. Equipment: List equipment type & rating (e.g., lighting, AC, refrigeration, heating (water or space), cooking, elevators, pumps, pool, etc.; Attach separate sheet for additional equipment.)

D. Services Need by Date:

V. Billing Information: Energy Usage (Party responsible for energy usage after meter is installed)

A. Name to Appear on Bill:

Are you an existing customer?

B. Billing Contact Information:

C. Billing Address:

D. Responsible Party Is: (Select one)

E. For New Residential Customers:

F. For New Commercial Customers:

Business Type: (Select one)

VI. Billing Information: Construction Cost (Party responsible for construction costs)

If Same Above, Check Here:

A. Name to Appear on Bill:

Are you an existing customer?

B. Billing Contact Information:

C. Billing Address:

D. Responsible Party Is: (Select one)

E. For New Residential Customers:

F. For New Commercial Customers:

Business Type: (Select one)

VII. Submittals: (Items that are being submitted to Hawaiian Electric Company)

A. Select All Items to be Submitted:

B. Type of Drawings:

C. Drawings will be Sent Via:

Email:

Courier:

VIII. Remarks: Please provide additional information that will help us complete your request.

Billing Acceptance and Acknowledgement

Please acknowledge the billing agreement by checking the checkbox.

I. Requestor: (Party who will provide project information and updates to Hawaiian Electric Company)

II. PROJECT INFORMATION:

III. ALTERNATE POWER:

IV. Consultant Requests Only: (Complete this section)

V. Billing Information: Energy Usage (Party responsible for energy usage after meter is installed)

VI. Billing Information: Construction Cost (Party responsible for construction costs)

VII. Submittals: (Items that are being submitted to Hawaiian Electric Company)

VIII. Remarks: Please provide additional information that will help us complete your request.

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