Service Request Form

[contact-form subject=”AEC Website: Service Request” to=”engineering@adamselectric.coop”] [contact-field label=”Member Account Name” type=”name” required=”true” /] [contact-field label=”Account Number” type=”text” /] [contact-field label=”Map Number” type=”text” /] [contact-field label=”Email” type=”email” /] [contact-field label=”Service Address” type=”text” required=”true” /] [contact-field label=”City” type=”text” required=”true” /] [contact-field label=”Zip Code” type=”text” required=”true” /] [contact-field label=”Daytime Phone Number” type=”text” required=”true” /] [contact-field label=”Choose one:” type=”radio” required=”true” options=”New electric service,Upgrade electric service,Security light,Tree trimming/spraying,Other (Please comment)” /] [contact-field label=”Comment” type=”textarea” /] [/contact-form]

Adams Electric Cooperative
Mailing address: P.O. Box 247, Camp Point, IL 62320
Headquarters Location: 700 E. Wood St., Camp Point, IL
Phone: 217-593-7701 – Fax: 217-593-7120