A note before you get started...

This form includes a save and resume feature. Instructions for computers and mobile devices can be found below.

If you're using a computer:

Click the save icon at the bottom of the screen.
On the screen that appears, click "Skip Create an Account".
Enter your email address and click "Send" to receive an email with a link to come back to your saved draft.

If you're using a mobile device:

Tap the status bar at the bottom of the screen where it says, for example, "2 of 21."
Tap the save icon at the top of the screen.
Tap "Skip Create an Account".
Enter your email address and tap "Send" to receive an email with a link to come back to your saved draft.

If you have any questions, please reach out to us at (800) 835-9586.

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Name of Business* This field is required.

3

Type of product being manufactured or sold* This field is required.

4

Fed/State Tax ID#* This field is required.

5

Name and Title of Requestor* This field is required.

6

Billing Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

7

Email Address* This field is required.

example@example.com

8

Daytime Phone Number

Please enter a valid phone number.

9

Cell Phone Number

Please enter a valid phone number.

10

Are you already a member of Heartland REC?* This field is required.

Yes

No

11

Heartland Account NumberYour account number can be found on your printed bill or online in your SmartHub account.

12

Does the location at which you are applying for new service have a mailing address?* This field is required.

Yes

No

13

New Service Mailing AddressIf this is a lake lot, please include the plat and lot numbers in the "Street Address Line 2" field.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

14

Nearest Intersection to Desired Service Location

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New Service Location InformationBe sure to scroll through each field before continuing.

Type here:

Plat

Lot

Township

Range

Section

Subdivision/Lake Area

Unit

Plat

Lot

Township

Range

Section

Subdivision/Lake Area

Unit

Type here:

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Connected Load Information (kW)* This field is required.Be sure to scroll through each field before continuing.

Enter kW Here:

Lighting

Heating

Air Conditioning

Total Motor HP

Largest Motor HP

Estimated Peak kW

Lighting

Heating

Air Conditioning

Total Motor HP

Largest Motor HP

Estimated Peak kW

Enter kW Here:

18

Are you requesting service for a newly built structure?* This field is required.

YESNO

19

New Structure Construction Start Date

Date

20

New Structure Construction End Date

Date

21

If requesting new service for an existing structure, please indicate any improvements that have been or will be made to the property, and the approximate date of completion.Be sure to scroll through each field before continuing.

Improvements Made?

Date of Improvements

Water/Plumbing

Septic System

Foundation

Water/Plumbing

Septic System

Foundation

Improvements Made?

Date of Improvements

Improvements Made?

Date of Improvements

Improvements Made?

Date of Improvements

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Field Visit and Engineering Deposit

Projects require a field visit prior to preparing a cost summary. But before a field visit can be scheduled, an engineering deposit must be paid.

The deposit is non-refundable, but will be applied to project costs if service is built within 12 months of original application. If the project is deemed inactive after 12 months, the work order will be closed and a new application and deposit will be required if the applicant wishes to establish service.

For commercial projects, the amount of the engineering deposit varies depending on the size of service:

Line Extension Type	Deposit Amount
Small Commercial	$250
General Commercial (25 kVA - 499 kVA)	$350
Three-Phase (500 kVA and greater)	As determined by Engineering Dept.
Developments (Single or Three-Phase)	$100 per lot

Information on paying the engineering deposit will be emailed to you upon form submission.

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Field Visit Information* This field is required.Be sure to scroll through each field before continuing.

Type Here:

Party to Contact:

Preferred time of day for field visit:

Phone number:

Party to Contact:

Preferred time of day for field visit:

Phone number:

Type Here:

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Field Visit Information

During the field visit, specific questions can be answered on-site by the staking technician. After the field visit, the staking technician will prepare a cost summary and necessary paperwork. Applicant must complete and sign all paperwork and return it to the office with payment of all necessary charges.

Design and Installation

The design and installation of your line extension and service will be based on the Rules and Regulations and the Line Extension Policy of Heartland REC. Heartland REC will solely determine the capability of the system to provide your service requirement along with the route and most cost-effective design.

Easements

For all line extension projects, the Cooperative will require easements for the purpose of construction, servicing, repair, adding of circuits, and replacement of the Cooperative lines necessary to provide service to the Cooperative membership and to others who enter into agreements for electric service from the Cooperative. The easement process is as follows:

The applicant will work out agreements with any affected landowners.
Heartland will send an easement form to the applicant.
The applicant will sign the form, have it notarized, and mail it back to Heartland.
Heartland will file the easement at the appropriate courthouse.
Heartland will add any court filing costs to the final construction bill.

Heartland crews will not begin construction until all required easements have been filed.

Right-of-Way Clearing

Clearing of all right-of-way required for the line extension is the sole responsibilty of the applicant. All right-of-way will be cleared to meet Rural Utility Services (RUS) specifications. Heartland crews will not begin construction until right-of-way clearing has been performed to RUS specifications.

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If you would like to provide any additional information about this project, please use the space below.

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Agreement to Accept Service: I hereby apply for electrical service as indicated herein. I understand that Heartland REC will make service available upon the completion of engineering details and a duly extended contractual agreement between the parties. I agree to accept service when construction is completed.* This field is required.If on a phone or tablet, use your finger to draw your signature in the space below. If on a computer, use your mouse or touchpad to draw your signature in the space below.

Clear