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
RCHW100-120
$
x
$
0.00
8-Plug,AC,Fax/Tele,Coax,Ethernet
TLP810NET
$
x
$
0.00
6-Plug,AC,Fax/Tele,Coax
HTSWIVEL6
$
x
$
0.00
4-Plug,AC Only
TLP4BK
$
x
$
0.00
3-Plug, AC, 2 USB Ports
TRAVELER3USB
$
x
$
0.00
1-Plug, AC Only
SPIKECUBE
$
x
$
0.00
1-Plug, AC & Fax/Tele
TRAVELCUBE
$
x
$
0.00
AC Outlet Tester
CT120
$
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 2011-2013 All Rights Reserved by
Menard Electric Cooperative and AgPage Int. Consulting, LLC
