Request for Physical Disconnect

1. Account Number *This question is required.

2. Legal Owner's Name *This question is required.

3. Legal Owner's Address

Address *This question is required.

City *This question is required.

State *This question is required.

Zip Code *This question is required.

4. Phone Number *This question is required.

5. Meter Removal Information

Address *This question is required.

City *This question is required.

State *This question is required.

Zip Code *This question is required.

Meter Number *This question is required.

Date Needed By *This question is required. This question requires a valid date format of MM/DD/YYYY.

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6. Please indicate reason for this request. If unsure, please call (218) 355-2644 for assistance. *This question is required.

7. Will the property require electrical service in the future? *This question is required.

Please fill out a new construction request.

7. Please explain: *This question is required.

By completing this form, I acknowledge I am authorized to make this request and agree that Minnesota Power will not be held responsible for any damage at the address above due to discontinuation of electrical service.

I understand that if the power is reconnected at this address within the next 12 months, under my account, I will be back-billed the monthly minimums for up to 12 months.

I understand that if Minnesota Power is requested to reinstall facilities at this location in the future all applicable Line Extension Rules and associated costs will apply.

This request must be received at least 7 days prior to the date power needs to be physically disconnected. You may be contact after receipt of request for scheduling.

7. Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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8. Signature *This question is required.

Clear

Signature of

*Information is required to complete this request—incomplete documentation may delay the date power is turned off.