8925 State Hwy 111 S                                                                       6200 7th Street

Edna, TX (361)782-4400                                                       Bay City, TX (979)245-3029


Customer Owned Meter Loop/Meter Pole Request and Purchase Agreement  

(Single phase 120/240 volt only)

           All items subject to 6.75% taxes and prices are subject to change without notice


I propose to purchase the following metering equipment and items from JEC:



200-amp meter loop with 200-amp main breaker and 2 double pole positions - 2-#3/0 and 1-#1/0 copper THW in 2" rigid aluminum conduit


                                                                                                $989.00 w/ or w/o pole-includes installation


Price $        989.00          + Taxes of 6.75% $ _66.76_____   Total  Purchase = $_1,055.76___________



Method of Payment:

Credit Card #_______________________   Visa- MasterCard- Discover- American Express

         Check#_______________________     Expiration: ______________



By signature below, I request the above marked meter loop items to be furnished and installed by Jackson Electric Coop, Inc.


Member Name ______________________________                                                                                 Date signed _______________________


Signature __________________________________                                                                                  Bay City Area _______ Edna Area _______


Account # ___________________________