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Residential Surge Guard
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Residential Surge Guard
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Customer Information
First Name
Middle Initial
Last Name
Email Address
Daytime Phone:
-
-
Evening Phone:
-
-
Service Address
Address
Apt/Unit
City
State
IA
KS
NE
Zip
Installation Information
Do you have cable television?
Yes
No
a. If yes, who is your service provider?
Do you have a satellite dish?
Yes
No
a. If yes, how many receivers do you have inside your home?
Do you have a home telephone?
Yes
No
a. If yes, who is your service provider?
b. If yes, how many telephone numbers (lines) do you have?
Is your power meter located on your house?
Yes
No
Do you have an outbuilding or detached garage?
Yes
No
Do you have a personal well?
Yes
No
How did you hear about OPPD's Whole House Surge Guard Protection?
eBill
Radio
TV
Website
Referral
Bill Insert
If you have a promotional code, please enter:
I have read and agree with the
Terms and Conditions
.