BACK I (we) authorize DEMCO to install a security light based on the terms and conditions of the Consumer Handbook guidelines. I also understand that the $10.00 or $110.00 fee must be paid-in-full prior to the light being installed (cannot be billed). * yes Is the electric service to your home provided by overhead power lines? * yes no Is there a DEMCO service pole located where you want the security light installed? * yes no Customer name as appears on bill: First name * Middle name Last name * DEMCO account number * Contact home phone * Contact work phone * Mailing address: Street address * City * State * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Installation instructions: Which pole should the light be installed on? * Which direction should the light face? * Do you have any locked gates? * yes no Do we need to schedule an appointment? * yes no Type of Light * 100-Watt Sodium Vapor (7,000 - 10,000 Lumens).................$8.30* 250-Watt Sodium Vapor (10,001 - 29,000 Lumens)..............$13.95* 400-Watt Sodium Vapor (29,001 - 60,000 Lumens)..............$28.97* 1000-Watt Sodium Vapor (60,001 -155,000 Lumens) ..........$52.41* *Plus fuel cost adjustment
