Form Submitted by:
Name (Full Name)
Title
Email Address
Type
Please select...
251-252 Interconnection Information Request Form
Legal Entity Name
Legal Entity Name including d/b/a and punctuation, as registered with the Secretary of State where your company is incorporated.
State of Incorporation
Please select...
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Does your company have an ACNA?
Yes
No
ACNA (aka IAC Code) is a three-character alphabetic code.
ACNA
Headquarters or Principal Place of Business Address
Street Address
City
State
Please select...
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
Country
Email Address of person to receive Executable Document & Final, Fully Executed Document
Email Address