Miscellaneous Engineering Inquiry Application

A $75 application fee is required when submitting a new construction application to KV REMC.

Name(Required)

First Last

Phone(Required)

Email(Required)

Meter Number(Required)

Pole Number(Required)

Service Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Inquiry Type

Disconnect/Reconnect

Security Lights

Service Retirement

Work Order Status

Blinks/ Outages

Joint Use/ Pole Attachment

Rates

Contractor

Other

Notes

Consent(Required)

I hereby verify the information to be true and complete. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.

Fee(Required)

I understand that I am required to pay a $75 application fee. An engineer will only review your application once the payment is made. Only cash, check or money orders are allowed as payment.

Applicant Electronic Signature (Full Name)(Required)

Name

This field is for validation purposes and should be left unchanged.