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NEW YORK STATE ELECTRIC & GAS CORPORATION @i Streetlight Request Form Service Ciass 3 ‘Customer Information 10012714621 Fixtures Project Notes 2 cates, ‘ ‘Other Information @ This form must be submitted to your NYSEG representative along with written authorization from the Municipality to install or remove the equipment indicated. ® Please include a sketch/layout if new poles are being installed. initial term plus any balance due on service rendered to the time of termination. '@ Non-L€D streetlights are no longer available as of 12/1/2020. }* All failures of existing Streetlights Lights will be replaced with an LED Streetlights Light of comparable size. '@ It is the Customer's responsibility to select the Luminaire, Lamp, Wattage, and Bracket, The Company does not provide lighting design service. |e Additional information regarding NYSEG Streetlight service can be found in NYSEG's Streetlight Tariff. Signatures