Outdoor Lighting Options
*Indicates required field
Date Service is Needed:
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Name on Account:
*First Name:
*Last Name:
*E-mail Address:
*8-Digit Meter Number:
Home Phone: (
)
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Cell Phone: (
)
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Work Phone: (
)
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Billing Address:
City:
State:
Zip Code:
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Street Address:
Former Blue Ridge Member? Yes
No
If Yes, When?
Would you like to request an outdoor security light? Yes
No
Is there an existing pole that the light can be mounted on? Yes
No
If no, put a stake where you would like the crew to place the pole, being aware of drain lines, telephone/electric lines, your septic tank or any other underground facility!
What type of light do you want? (click here for options)
175 Watt Mercury Vapor (blue colored) Basic $12.50/month 30' mounted height
250 Watt HPS (amber colored) Cobrahead $17.50/month 25' mounted height
400 Watt HPS (amber colored) Cobrahead $21.75/month 35' mounted height
Specialty/Decorative Light (A representative will contact you)
Please indicate where you want the light placed and which way you want the light to face:
*Forwarding Address:
*City:
*State:
*Zip Code:
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Is there a working outdoor security light to disconnect? Yes
No
If yes, please give the serial number for the outdoor security light: (S/N is found on a silver tag on the pole and begins with 100, 200, 300, or 400)
Comments:
