{"id":39018,"date":"2022-07-22T07:53:09","date_gmt":"2022-07-22T14:53:09","guid":{"rendered":"https:\/\/www.ghpud.org\/?page_id=39018"},"modified":"2022-08-29T15:11:25","modified_gmt":"2022-08-29T22:11:25","slug":"existing-service-request","status":"publish","type":"page","link":"https:\/\/www.ghpud.org\/customer-service\/service-applications-online-forms\/existing-service-request\/","title":{"rendered":"Existing Service Request"},"content":{"rendered":"<p>You may also download the <a href=\"https:\/\/www.ghpud.org\/wp-content\/uploads\/05-005-Existing-Service-Request-1.pdf\" target=\"_blank\" rel=\"noopener\">Existing Service Request (PDF)<\/a>.<\/p>\n<p>Please also fill out the <a href=\"https:\/\/www.ghpud.org\/customer-service\/service-applications-online-forms\/residential-application\/\">Residential Application<\/a> or <a href=\"https:\/\/www.ghpud.org\/customer-service\/service-applications-online-forms\/commercial-application\/\">Commercial Application<\/a><\/p>\n<p><strong>This application must be completely filled out to process your application and provide you service.<\/strong> Please complete all sections applicable to your installation.<\/p>\n<p>Questions? Call <a href=\"&quot;tel:+1-360-532-4220\">(360) 532-4220<\/a>.<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_23' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_23'  action='\/wp-json\/wp\/v2\/pages\/39018' data-formid='23' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_23' class='gform_fields top_label form_sublabel_above description_above'><fieldset id=\"field_23_1\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_1\"><legend class='gfield_label gform-field-label'  >Have You Had An Account With Grays Harbor PUD No. 1?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_1'>\n\t\t\t<div class='gchoice gchoice_23_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Yes'  id='choice_23_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_1_0' id='label_23_1_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='No'  id='choice_23_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_1_1' id='label_23_1_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_26\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_26\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Service Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_23_26' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_23_26_1_container' >\n                                        <label for='input_23_26_1' id='input_23_26_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_26.1' id='input_23_26_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_23_26_2_container' >\n                                        <label for='input_23_26_2' id='input_23_26_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_26.2' id='input_23_26_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_23_26_3_container' >\n                                    <label for='input_23_26_3' id='input_23_26_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_26.3' id='input_23_26_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_23_26_4_container' >\n                                        <label for='input_23_26_4' id='input_23_26_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_26.4' id='input_23_26_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' selected='selected'>Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_23_26_5_container' >\n                                    <label for='input_23_26_5' id='input_23_26_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_26.5' id='input_23_26_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_26.6' id='input_23_26_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_23_4\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_4\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Customer\/Tenant Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_23_4'>\n                            \n                            <span id='input_23_4_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_23_4_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_4.3' id='input_23_4_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_23_4_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_23_4_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_4.6' id='input_23_4_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_23_5\"  class=\"gfield gfield--type-phone field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_5\"><label class='gfield_label gform-field-label' for='input_23_5' >Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_23_5' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_23_6\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_6\"><label class='gfield_label gform-field-label' for='input_23_6' >Work or Cell Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_23_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_23_40\"  class=\"gfield gfield--type-email gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_40\"><label class='gfield_label gform-field-label' for='input_23_40' >Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_40' id='input_23_40' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_23_3\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_3\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Mailing Address for Billing<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    <div id='input_23_3_copy_values_option_container' class='copy_values_option_container' >\n                                        <input type='checkbox' id='input_23_3_copy_values_activated' class='copy_values_activated' value='1' data-source_field_id='26' name='input_3_copy_values_activated'  \/>\n                                        <label for='input_23_3_copy_values_activated' id='input_23_3_copy_values_option_label' class='copy_values_option_label inline gform-field-label gform-field-label--type-inline'>Same as previous<\/label>\n                                    <\/div>\n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_23_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_23_3_1_container' >\n                                        <label for='input_23_3_1' id='input_23_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_3.1' id='input_23_3_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_23_3_2_container' >\n                                        <label for='input_23_3_2' id='input_23_3_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_3.2' id='input_23_3_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_23_3_3_container' >\n                                    <label for='input_23_3_3' id='input_23_3_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_3.3' id='input_23_3_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_23_3_4_container' >\n                                        <label for='input_23_3_4' id='input_23_3_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_3.4' id='input_23_3_4' value=''      aria-required='true'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_23_3_5_container' >\n                                    <label for='input_23_3_5' id='input_23_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_3.5' id='input_23_3_5' value=''    aria-required='true'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_23_3_6_container' >\n                                        <label for='input_23_3_6' id='input_23_3_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_3.6' id='input_23_3_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_23_8\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_8\"><label class='gfield_label gform-field-label' for='input_23_8' >Doing Business As (DBA)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_23_8' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_9\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_9\"><label class='gfield_label gform-field-label' for='input_23_9' >Owner\/Landlord Name (If Different Than Customer Name)<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_23_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_11\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_11\"><label class='gfield_label gform-field-label' for='input_23_11' >Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_23_11' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_23_10\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_10\"><label class='gfield_label gform-field-label' for='input_23_10' >Electrical Contractor Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_23_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_41\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_41\"><label class='gfield_label gform-field-label' for='input_23_41' >Electrical Contractor Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_23_41' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_12\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_12\"><h3 class=\"gsection_title\">Services Requested<\/h3><\/div><fieldset id=\"field_23_14\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_14\"><legend class='gfield_label gform-field-label'  >Safety Inspection (Service has been disconnected\/off for more than 1 year)<\/legend><div class='gfield_description' id='gfield_description_23_14'>(Requires a \"Wiring OK\" from the appropriate authority prior to reconnection of service)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_14'>\n\t\t\t<div class='gchoice gchoice_23_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_23_14_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_23_14\"   \/>\n\t\t\t\t\t<label for='choice_23_14_0' id='label_23_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_23_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_14_1' id='label_23_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_15\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_15\"><legend class='gfield_label gform-field-label'  >Rate Schedule Change<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_15'>\n\t\t\t<div class='gchoice gchoice_23_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes'  id='choice_23_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_15_0' id='label_23_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_23_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_15_1' id='label_23_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_42\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_42\"><label class='gfield_label gform-field-label' for='input_23_42' >What Rate Would You Like to Change?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_23_42' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_43\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_43\"><label class='gfield_label gform-field-label' for='input_23_43' >Reason<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_23_43' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_16\"  class=\"gfield gfield--type-text field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_16\"><label class='gfield_label gform-field-label' for='input_23_16' >Meter Number of Service Requiring Application<\/label><div class='gfield_description' id='gfield_description_23_16'>(6-digit number)<\/div><div class='ginput_container ginput_container_text'><input name='input_16' id='input_23_16' type='text' value='' class='large'  aria-describedby=\"gfield_description_23_16\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_23_17\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_17\"><legend class='gfield_label gform-field-label'  >Remove Meter &amp; Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_23_17'>(Permanently remove a meter service wire)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_17'>\n\t\t\t<div class='gchoice gchoice_23_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Yes'  id='choice_23_17_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_23_17\"   \/>\n\t\t\t\t\t<label for='choice_23_17_0' id='label_23_17_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='No'  id='choice_23_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_17_1' id='label_23_17_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_18\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_18\"><label class='gfield_label gform-field-label' for='input_23_18' >Reason<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_23_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_23_19\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_19\"><legend class='gfield_label gform-field-label'  >Added Load (Adding load to current service)<\/legend><div class='gfield_description' id='gfield_description_23_19'>(Requires a \"Wiring OK\" from the appropriate authority prior to reconnection of service)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_19'>\n\t\t\t<div class='gchoice gchoice_23_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_23_19_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_23_19\"   \/>\n\t\t\t\t\t<label for='choice_23_19_0' id='label_23_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_23_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_19_1' id='label_23_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_20\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_20\"><label class='gfield_label gform-field-label' for='input_23_20' >New Load (Kilowatts or Watts)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_23_20' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_21\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_21\"><label class='gfield_label gform-field-label' for='input_23_21' >Load Type<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_23_21' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_22\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_22\"><label class='gfield_label gform-field-label' for='input_23_22' >Previous Load (kilowatts)<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_23_22' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_23_25\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_25\"><legend class='gfield_label gform-field-label'  >Adding Heat Pump<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_25'>\n\t\t\t<div class='gchoice gchoice_23_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_23_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_25_0' id='label_23_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_23_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_25_1' id='label_23_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_23\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_23\"><label class='gfield_label gform-field-label' for='input_23_23' >Locked-Rotor Amperes<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_23_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_24\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_24\"><label class='gfield_label gform-field-label' for='input_23_24' >Ton<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_23_24' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_23_27\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_27\"><legend class='gfield_label gform-field-label'  >Relocate Service Equipment (Move service equipment to new location)<\/legend><div class='gfield_description' id='gfield_description_23_27'>(Requires a \"Wiring OK\" from the appropriate authority prior to reconnection of service)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_27'>\n\t\t\t<div class='gchoice gchoice_23_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes'  id='choice_23_27_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_23_27\"   \/>\n\t\t\t\t\t<label for='choice_23_27_0' id='label_23_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No'  id='choice_23_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_27_1' id='label_23_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_48\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_48\"><label class='gfield_label gform-field-label' for='input_23_48' >Notes on new service equipment location<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_48' id='input_23_48' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_23_28\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_28\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Action to be taken<\/legend><div class='gfield_description' id='gfield_description_23_28'>(Check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_23_28'><div class='gchoice gchoice_23_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Temporary Disconnect'  id='choice_23_28_1'   aria-describedby=\"gfield_description_23_28\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_23_28_1' id='label_23_28_1' class='gform-field-label gform-field-label--type-inline'>Temporary Disconnect<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_28_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.2' type='checkbox'  value='Convert from Overhead to Underground'  id='choice_23_28_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_28_2' id='label_23_28_2' class='gform-field-label gform-field-label--type-inline'>Convert from Overhead to Underground<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_29\"  class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_29\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Date Desired for Disconnect (mm\/dd\/yyyy)<\/legend><div id='input_23_29' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_23_29_1_container'>\n                                            <label for='input_23_29_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <input type='number'  name='input_29[]' id='input_23_29_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_23_29_2_container'>\n                                            <label for='input_23_29_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                            <input type='number'  name='input_29[]' id='input_23_29_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_23_29_3_container'>\n                                            <label for='input_23_29_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                            <input type='number'  name='input_29[]' id='input_23_29_3' value=''   aria-required='false'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_23_30\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_30\"><label class='gfield_label gform-field-label' for='input_23_30' >Trenching By<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_23_30' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_23_31\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_31\"><legend class='gfield_label gform-field-label'  >Replace\/Upgrade Service Equipment at Current Location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_23_31'>(Requires a \"Wiring OK\" from the appropriate authority prior to reconnection of service)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_31'>\n\t\t\t<div class='gchoice gchoice_23_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_23_31_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_23_31\"   \/>\n\t\t\t\t\t<label for='choice_23_31_0' id='label_23_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_23_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_31_1' id='label_23_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_32\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_32\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Action to be taken<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_23_32'>(Check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_23_32'><div class='gchoice gchoice_23_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Upgrading Service'  id='choice_23_32_1'   aria-describedby=\"gfield_description_23_32\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_23_32_1' id='label_23_32_1' class='gform-field-label gform-field-label--type-inline'>Upgrading Service<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_32_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.2' type='checkbox'  value='Temporary Disconnect Required'  id='choice_23_32_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_32_2' id='label_23_32_2' class='gform-field-label gform-field-label--type-inline'>Temporary Disconnect Required<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_32_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.3' type='checkbox'  value='Replacing Meter Base'  id='choice_23_32_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_32_3' id='label_23_32_3' class='gform-field-label gform-field-label--type-inline'>Replacing Meter Base<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_32_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.4' type='checkbox'  value='Replacing Mast'  id='choice_23_32_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_32_4' id='label_23_32_4' class='gform-field-label gform-field-label--type-inline'>Replacing Mast<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_32_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.5' type='checkbox'  value='Replacing Panel'  id='choice_23_32_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_32_5' id='label_23_32_5' class='gform-field-label gform-field-label--type-inline'>Replacing Panel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_23_32_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.6' type='checkbox'  value='Relocating Service to Another Location'  id='choice_23_32_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_23_32_6' id='label_23_32_6' class='gform-field-label gform-field-label--type-inline'>Relocating Service to Another Location<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_46\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_46\"><legend class='gfield_label gform-field-label'  >Upgrading Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_46'>\n\t\t\t<div class='gchoice gchoice_23_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='From 100 amp to 200 amp'  id='choice_23_46_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_46_0' id='label_23_46_0' class='gform-field-label gform-field-label--type-inline'>From 100 amp to 200 amp<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='From 200 amp to 400 amp'  id='choice_23_46_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_23_46_1' id='label_23_46_1' class='gform-field-label gform-field-label--type-inline'>From 200 amp to 400 amp<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_33\"  class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_33\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Date Desired for Disconnect (mm\/dd\/yyyy)<\/legend><div id='input_23_33' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_23_33_1_container'>\n                                            <label for='input_23_33_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <input type='number'  name='input_33[]' id='input_23_33_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_23_33_2_container'>\n                                            <label for='input_23_33_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                            <input type='number'  name='input_33[]' id='input_23_33_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_23_33_3_container'>\n                                            <label for='input_23_33_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                            <input type='number'  name='input_33[]' id='input_23_33_3' value=''   aria-required='false'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_23_34\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_34\"><label class='gfield_label gform-field-label' for='input_23_34' >New Meter Base Size<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_23_34' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_35\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_35\"><label class='gfield_label gform-field-label' for='input_23_35' >Existing Meter Base Size<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_23_35' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_37\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_37\"><label class='gfield_label gform-field-label' for='input_23_37' >New Mast Size<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_23_37' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_36\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_36\"><label class='gfield_label gform-field-label' for='input_23_36' >Existing Mast Size<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_23_36' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_23_38\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_38\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_38.1' id='input_23_38_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_23_38_1' >This request expires 12 months from the date of application. I affirm that the above information is correct to the best of my knowledge. I also understand that any changes I make will increase the time required for PUD to provide service and I might be liable for additional cost.<\/label><input type='hidden' name='input_38.2' value='This request expires 12 months from the date of application. I affirm that the above information is correct to the best of my knowledge. I also understand that any changes I make will increase the time required for PUD to provide service and I might be liable for additional cost.' class='gform_hidden' \/><input type='hidden' name='input_38.3' value='18' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_23_39\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_39\"><label class='gfield_label gform-field-label' for='input_23_39' >Electronic Signature (Full Name)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_23_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_47\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_47\"><label class='gfield_label gform-field-label' for='input_23_47' >Notes<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_47' id='input_23_47' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_23_49\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_23_49\"><label class='gfield_label gform-field-label' for='input_23_49' >Name<\/label><div class='gfield_description' id='gfield_description_23_49'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_49' id='input_23_49' type='text' value='' autocomplete='new-password'\/><\/div><\/div><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_23' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_23\"]){return false;}  if( !jQuery(\"#gform_23\")[0].checkValidity || jQuery(\"#gform_23\")[0].checkValidity()){window[\"gf_submitting_23\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_23\"]){return false;} if( !jQuery(\"#gform_23\")[0].checkValidity || jQuery(\"#gform_23\")[0].checkValidity()){window[\"gf_submitting_23\"]=true;}  jQuery(\"#gform_23\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_23' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='23' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_23' value='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' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_23' id='gform_target_page_number_23' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_23' id='gform_source_page_number_23' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 23, 'https:\/\/www.ghpud.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_23').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_23');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_23').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_23').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_23').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_23').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_23').val();gformInitSpinner( 23, 'https:\/\/www.ghpud.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [23, current_page]);window['gf_submitting_23'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_23').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [23]);window['gf_submitting_23'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_23').text());}, 50);}else{jQuery('#gform_23').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [23, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 23, currentPage: current_page } });} );} );\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"<p>You may also download the Existing Service Request (PDF). Please also fill out the Residential Application or Commercial Application This application must be completely filled out to process your application and provide you service. Please complete all sections applicable to your installation. Questions? Call (360) 532-4220.<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":37425,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"_links":{"self":[{"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/pages\/39018"}],"collection":[{"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/comments?post=39018"}],"version-history":[{"count":4,"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/pages\/39018\/revisions"}],"predecessor-version":[{"id":39113,"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/pages\/39018\/revisions\/39113"}],"up":[{"embeddable":true,"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/pages\/37425"}],"wp:attachment":[{"href":"https:\/\/www.ghpud.org\/wp-json\/wp\/v2\/media?parent=39018"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}