Surge Protection Device Order Form
Account Information
Your Name (First & Last):
Street:
City:
State:
Zip:
Home Phone:
Email Address:
Please provide me with:
Basic Protection Plan ($4.95/month)
Premium Protection Plan ($5.95/month plus $49.95 for point of use package)
MEC Account #:
Customer Signature:
Order Information
Please provide me with the following surge protection devices:
Item
Cat. No.
Price
Quantity
Total
Main Panel Whole House
HGD-1ARSE
$
x
$
0.00
Point of Use Protector Kit
HGD-113SK
$
x
$
0.00
8-Plug, AC & Fax/Tele
HGD8-2ET
$
x
$
0.00
8-Plug, AC & Fax/Tele w/Coax
HGD-214
$
x
$
0.00
3-Plug, AC Only
HGD3-1ES
$
x
$
0.00
1-Plug, AC Only
HGD1-0ES
$
x
$
0.00
1-Plug, AC & Fax/Tele
HGD1-0ET
$
x
$
0.00
1-Plug, AC w/Coax
HGD1-0EC
$
x
$
0.00
Grand Total =
$
0.00
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Menard Electric Cooperative
14300 State Hwy 97
PO Box 200
Petersburg, IL 62675-0200
(800) 872-1203 or (217) 632-7746
Email - info@menard.com
Copyright 2009-2010 All Rights Reserved by
Menard Electric Cooperative and AgPage Int. Consulting, LLC
