Permanent Service
P. O. Box 897 Douglasville, Georgia, 30132

PERMANENT SERVICE AGREEMENT
AND
RELEASE FOR OVERHEAD AND/OR UNDERGROUND
ELECTRIC SERVICE CONSTRUCTION

Service Location:
*Account Name:
*Subdivision Name:
*Lot:
*Address:
*County:
*City:
*State:
*Zip Code:
*Utility Type:
Should we disconnect and retire an existing temporary pole?
*Retire temporary pole:
Authorized Representative Information:
Any phone number, including wireless, may be used by GreyStone Power to contact you.
*Name:
Title:
*Office Phone:
Cell Phone:
Fax:
*Email Address:
When providing electrical service to the above address GreyStone Power may be required to install overhead facilities, pole(s), and/or guy wire (s) and/or anchor(s).

When requested and/or available, installing underground facilities will require that GreyStone Power use shovel, backhoe, and/or trencher(s). The owner / developer / builder assume all liability for damage to facilities not properly located, marked, or identified. This includes all facilities installed but not limited to septic/sewer, sprinkler systems and/or other utilities, and is the responsibility of the owner / developer / builder to properly identify all these facilities. GreyStone Power will make every reasonable effort to avoid damage to such facilities.

Locate marks should be maintained and visually evident when the installation of electric lines begins.

Access to the property must be available. GreyStone Power will not be liable for damage to retaining walls, driveways, sidewalks, lawns or flowerbeds if they are in the direct path of construction of the electric lines and in the agreed upon service corridor.

I acknowledge that the meter base has been installed and that the service corridor is clear and will remain clear prior to service installation.

I, the Owner / Builder / Developer or Authorized Representative, have read, understand and agree to all of the above.

Please verify the following items:
*Lot is at final grade:
*Path is clear:
*Meter base is installed:

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Authorized Signature
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Date (MM/DD/YYYY)



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