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New Electric Service Installation

Welcome to Polk-Burnett!

Thank you for your inquiry. We are eager to assist you in getting started with your new electric service. To get the process started, click on the links below and fill out the following forms:

  1. Application for Electric Service and Co-op Membership
  2. New Service Data Sheet
  3. New Service Data Sheet - Three Phase (for three phase services only)
  4. Consumer Deposit – New Electric Service
  5. Right of Way Easement
    • Example of a completed Right of Way Easement (a guide on how to properly complete an easement)
      Special instructions for easements:

      • The easement must be printed on white paper only.
      • The easement must be filled out using black ink.
      • The easement must be signed in the presence of a Notary Public.
      • The original notarized easement must be returned to Polk Burnett Electric before construction of your new electric service begins.

Once the forms are submitted, an engineering technician will contact you to assist with your plans. You will be able to fill out the forms online, but will need to print and sign the necessary forms before returning them to Polk-Burnett at either of our two locations:

Centuria office:
1001 State Rd 35
Centuria, WI 54824

Siren office:
7298 State Rd 70
Webster, WI 54893

Note Regarding New Construction:
Effective Jan. 1, 2005, a signed Uniform Dwelling Code (UDC) Certificate is required prior to permanent connection of electrical service for many types of construction. Where applicable, this replaces the affidavit previously required by Polk-Burnett. The Affidavit by Electrical Contractor form continues to be required for other new service and rebuild projects. Contact your local building permit issuer, township clerk/chairman or your county zoning office for further information concerning the inspection process and to determining what type of certificate of electrical inspection is required.

For more information on how to install your electric service please see our Installing or Rebuilding Your Electric Service Guide. Note: Informational - Large file!

If you have any further questions, please do not hesitate to contact us in the Operations Department at 1-800-421-0283 or via email.

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