X/TwitterThis field is for validation purposes and should be left unchanged.A $250 estimate fee is required for all new construction applications. Please mail your check or drop off payment at our office: 1065 Hwy 13 P.O. Box 300 Grangeville, ID 83530 Email: iclp@iclp.coop The $250 Estimate Fee is nonrefundable and will be applied toward the cost of construction. ICL&P will only contact you to schedule the site visit upon receipt of payment. Contact InformationContact Name(Required)Who is receiving the estimate. First Last Phone(Required)Phone 2 (Optional)Email(Required) Enter Email Confirm Email Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Billing InformationWho will be paying the monthly bill once service is established.Indicate Membership(Required) Current Member New Member Previous Member Member Number(Required)Year of Previous Membership(Required)Member Name(s)(Required) First Last Member Name(s) First Last Member Phone(Required)Member Email(Required) Enter Email Confirm Email Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Location InformationWhere do you need power established/changed?Service is(Required) New Altered/Existing Unsure Parcel Number or Legal Description(Required)SubdivisionLot NumberPhysical AddressOfficial Street Address must be provided once assigned by the County if none is yet provided. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job InformationBrief Description of the Scope of Work(Required)Contractor InformationBuilding Contractor Name First Last Building Contractor PhoneElectrical Contractor Name(Required) First Last Electrical Contractor Phone(Required)Excavation Contractor Name First Last Excavation Contractor PhoneElectric Services InformationCheck/Fill-in Applicable ItemsPrimary Use Residential Commercial RV Service Irrigation Indicate Irrigation System Horsepower(Required)Greater than 10 Horsepower Requires 3-PhaseType of Structure(Required) Stick Log Pole Draw Masonry Other Describe Structure(Required)Type of Construction(Required) House (Single Family Dwelling) Modular Manufactured Home Multi-Family Addition Remodel Garage with Living Space Garage Shop Barn Other Describe Type of Construction(Required)Primary Heat(Required) House (Single Family Dwelling) Electric Furnace Propane Furnace Propane Fireplace Wood Stove Heat Pump Other Describe Primary Heat Source(Required)Additional LoadsWell/PumpWhat is the Horsepower?Hot TubWhat is the kW?EV ChargerWhat is the Amperage?OtherElectric Service SizeSingle Phase, Residential Voltage(Required)(120/240, 3-wire) Select Amps 100 Amps 200 Amps 320/400 Amps CT Service > 400 Amps 3-Phase, Commercial/Irrigation Voltage OptionsSelect Desired Voltage, and Amps 120/208 Volts, 4 Wire 277/480 Volts, 4 Wire 240/480 Volts, 4 Wire 200 Amps 400 Amps File UploadTo help us further understand your electrical service needs, you may upload a drawing or print out of your plot with estimated locations including homesite, meter base, driveway, fences, nearest ICL&P facility (pole, transformer, junction box, etc.), nearest public road, and septic line and/or drainfield. Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB, Max. files: 3. Acknowledgement of Terms(Required)The information contained herein is accurate to the best of my knowledge. I understand that if my service needs or location changes from what was originally provided there may be additional fees. I agreeType your name.(Required)This field is required for Federal e-Signature captures.Acknowledgement of Terms Signature Date(Required) MM slash DD slash YYYY This field is hidden when viewing the formICLP Use OnlyThis field is hidden when viewing the formFee Received Yes No This field is hidden when viewing the formDate Received (mm/dd/yyyy) Month Day Year This field is hidden when viewing the formMethod of PaymentThis field is hidden when viewing the formMember NumberThis field is hidden when viewing the formWork Request NumberThis field is hidden when viewing the formCopy to OSM Yes No This field is hidden when viewing the formSite Visit Date (mm/dd/yyyy) Month Day Year This field is hidden when viewing the formSite Visit Time Hours : Minutes AM PM AM/PM This field is hidden when viewing the formSTK NumberThis field is hidden when viewing the formW.O NumberThis field is hidden when viewing the formEST Paid Yes No This field is hidden when viewing the formDate Paid (mm/dd/yyyy) Month Day Year This field is hidden when viewing the formMethod of Payment Click to see the PDF version of this form
