AMEREN ILLINOIS CONSTRUCTION & ENGINEERING SERVICES
To ensure your order is processed immediately, please PRINT CLEARLY and fill out ALL information.
Billing Name: _______________________________________ Contact Person: _______________________________________
Billing Address: _________________________________________________________________________________________
City: ______________________________________________ State: ____________________ Zip Code: __________________
Daytime Phone: _____________ ext: ________ Cell:______________________ Fax:
_____________________
E-mail
: ____________________________________________ SSN/FEI
N#: _________________________________________
Preferr
ed Method of Contact: Daytime phone Cell phone Fax Email
SITE INFORMATION: Residential Commercial
Site Street Address: ______________________________________________________________________________________
City: ______________________________________________ State: ____________________ Zip Code: __________________
Nearest Cross Street: _____________________________________________________________________________________
Subdivision Name (if applicable): ________________________________________________ Lot Number: ________________
Structure Type (check one): Single Family Duplex Commercial Buildin
g Multi Unit
If Duplex or Multi Unit, please i
ndicate: Multi unit house meter? Yes No
One service line with multi
meters?
Yes No
One service line per unit? Yes No
TYPE OF SERVICE REQUESTED AND READY DATE
Temporary ____/____/___BBBB_ Permanent Electric ____
/____/__BBBB__ Gas ____/____/_BBBB___
TEMPORARY ELECTRIC SERVICE: OH UG Amp size ________ Dis
tance from pole/pedestal ____________
Note: Temporary service wi
ll be disconnected when permanent service is installed.
PERMANENT ELECTRIC SERVICE: Amp size _________ Single phase Three phase
Overhead in overhead area Underground in overhead area Underground in underground area
Approximate di
stance from a pole/transformer or pedestal to electric meter base: _____ feet
ELECTRIC: Electric meter should be installed on same side as Ameren facilities; not to exceed mid-point of house.
Install metering equipment per Ameren specs, NEC and local codes if subject to inspection. (See Service Manual)
On diagram at right, mark location of Electric, “E” to indicate Electric.
Inspection needed? Yes No If yes, when clear?BBBBBBBBBBBBBBB
Obstructions in path? Yes No
Lot within 6” of final grade? Yes No
Backfilled at foundation? Yes No
street
Perimeter of
building
(front)
Fax applications to 217-424-6758 or email IllinoisConstruction@ameren.com.
Applications may also be submitted online at www.buildwithamerenLOOLQRLV.com
Call 888-659-4540 if you have questions or need further information.
Note: A Representative from Ameren may call you to discuss your request further and/or schedule an
appointment to meet with a Local Field Engineering Representative.
