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*Required
Please complete the form below and press the "Submit" button when you are finished.
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| *Member # |
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| Do you have multiple meters? |
Yes:
No: |
| Your Name |
| *First Name |
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| Middle Name |
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| *Last Name |
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| Spouse's Name |
| First Name |
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| Middle Name |
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| Last Name |
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| Current Mailing Address |
| *Mailing Address |
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| *City |
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| State |
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| *Zip |
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| *Physical or 911 Address |
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| Contact Info |
| *Primary Phone |
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| 2nd Phone |
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| 3rd Phone |
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| *E-mail |
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| Would you like to get an occasional email note from BEC (planned outages, energy tips, important news)? |
Yes:
No: |
| Do you have a gate code? |
Yes:
No: |
| If yes, what is the code is |
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| Do you have a vicious dog (or animal)? |
Yes:
No: |
| Please attempt to contact me before entering my property. |
Yes:
No: |
Other information or special instructions:
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