Residential Surge Guard Sign-Up

First Name*

Last Name*

Email Address*

Daytime Phone*

Evening Phone*

Address*

Apt/Unit

City*

State or Province*

Zip Code*

Do you have cable television?*

Yes

No

If yes, who is your service provider? If no, put n/a.*

Do you have a satelite dish?*

Yes

No

If yes, how many receivers do you have in your home? If no, put n/a.*

Do you have a home telephone?*

Yes

No

If yes, who is your service provider? If no, put n/a.

If yes, how many telephone numbers(lines) do you have? If no, put n/a.*

Is your power meter located on your house?*

Yes

No

Do you have an outbuilding or detached garage?*

Yes

No

Do you have a personal well?*

Yes

No

How did you hear about OPPD's Whole House Surge Guard Protection?*

If you have a promotional code, please enter it here:

I have read and agree with the Terms and Conditions**