COMMERCIAL SURGE GUARD PROTECTION REQUEST FORM
BUSINESS INFORMATION
Business Name
*
OPPD Account Number
*
CONTACT INFORMATION
The person OPPD may contact about this service request
First Name
*
Last Name
*
Email Address
*
Daytime Phone
*
SERVICE ADDRESS
Address
*
Unit/Suite
City
*
State
*
Nebraska
Iowa
Kansas
Zip Code
*
*Commercial Surge Guard Protection
Terms and Conditions
and
Electrical/environmental Specifications