Date   
Name
Spouse Name  
Current Mailing Address 
Deed Information - Recorded in Volume  , Page or Document No. of  Bell Bosque Coryell Falls Hamilton McLennan Milam  county.
911 Address of the Property to be Served  Res Tel.   Bus. Tel.    Spouse Bus. Tel.    Mobile    Spouse Mobile 
Have you previously received service from HOTEC? Yes No  Or, do you currently receive service from HOTEC? Yes No
   If yes, is your new service request on the same property? Yes No If yes, what is your current meter number?
Are you the owner of the property being served? Yes   Rent /  Lease - Landlords Name 
Property Description:   acres situated in Bell Bosque Coryell Falls Hamilton McLennan Milam county and located miles north south      east west from the town of on Lot # Block # of subdivision, Unit

All meters must have a main disconnect located below or beside them. (See meter spec sheet for details)  All meters are to be located outside and accessible to cooperative employees.

REQUESTED LOCATION FOR METER  Permanently on meter pole set by the Cooperative Permanently on Dwelling/Building
VOLTAGE REQUIREMENTS 120 / 240 120 / 208 240 / 480 277 / 480
PROPOSED SIZE OF MAIN SERVICE ENTRANCE DISCONNECT
     60 amp    100 amp    125 amp    150 amp    200 amp    Other - Specify size
Total Connected HP     Size of Largest Motor                        

                          -------------------------------If over 200 amp provide load breakdown--------------------

TYPE OF SERVICE Overhead Underground Single Phase Three Phase (check all that apply)
FACILITY TO BE SERVED
   House - Sq. Feet  # of Rooms
   Mobile Home - Sq. Feet   or size   X
   Travel Trailer - Length
   Business - Type
   Hunting Cabin - Sq. Feet 
   Water Well Only - Used for 
   Other 
TYPE OF USE
  Permanent Residence
  Weekend / Vacation
  Seasonal
  Rental / Lease
  Spec. Home
  Other
STATUS OF FACILITY
  To Be Built
  Under Construction
  Completed
  To Be Moved
  Other 
WATER SUPPLY
  Drilled Well  Public Water Supply - Name
TYPE OF WASTE WATER FACILITIES
  Private Septic System - Is location marked? Yes No   Subdivision / Public / City Sewer
WHICH METHOD WILL YOU USE FOR WATER HEATING
  Electric - Size   Gas - Size     Tankless / On Demand    Other 
WHICH METHOD WILL YOU USE FOR AIR CONDITIONING
  Central Electric Air - # of Units    Size   Tons BTU kW
  Window / Wall - # of Units    Size   Tons BTU kW
  Other 
WHICH METHOD WILL YOU USE FOR HEATING
  Heat Pump
  Central Electric (strip heat)
  Electric Portable (space heaters)
  Central Gas
  Portable Gas
  Fireplace
   Other 
WHICH OF THE BELOW WILL YOU USE
   Electric Clothes Dryer
   Electric Range 
   Gas Clothes Dryer 
   Gas Range
   Swimming Pool or Hot Tub
  Refrigerator - How many? 
  Freezers - How many ? 
 
Is the Right of Way clear according to specs?  (unobstructed 10 ft on each side of the power line and 100 feet high) Yes No 

Gate Access must be provided.  Gate Code   If there is a chain, we will install our lock.

Do you want a security light installed?   Yes No  If yes, there will be a fee for installation.

LOAD DATA MUST BE COMPLETED AS MUCH AS POSSIBLE.  COST OF CHANGES DUE TO INADEQUATE OR INACCURATE INFORMATION WILL BE BORNE BY THE MEMBER.  INCOMPLETE DATA COULD DELAY CONSTRUCTION.