Net Metering Grid Interconnection Request Form
Customer Information
Name
Account Number
Service Address
City
State
ZIP
Phone
Email
Installer/Contractor Information
Installer Name
Company
Phone
Email
License Number
Generating Facility Information
Type of System
Solar PV
Wind
Other
Capacity (kW AC)
Inverter Make/Model
Inverter Quantity
Phase
Single
Three
Voltage (V)
Estimated Installation Date
Additional Information
Notes / Comments