APPLICATION FOR ELECTRIC SERVICE

APPLICATION FOR ELECTRIC SERVICE
APPLICANT NAME

First NameLast Name
SERVICE TYPE
DATE OF BIRTH

MonthDayYear
Date
DATE SERVICE IS TO BEGIN:

MonthDayYear
Date
MAILING ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SERVICE ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HOME NUMBER

Area CodePhone Number
BUSINESS NUMBER

Area CodePhone Number
CELL NUMBER

Area CodePhone Number
EMAIL
example@example.com
CONTACT PERSON (Not required. This is only if you would like to have a second contact person on your account)

First NameLast Name
I UNDERSTAND THAT THERE WILL BE A MEMBERSHIP FEE OF $5 AND AN ACCOUNT ESTABLISHMENT FEE OF $25 IN ORDER TO SET UP ELECTRIC SERVICE. A CUSTOMER SERVICE REPRESENTATIVE WILL CONTACT YOU REGARDING PAYMENT.

YESNO
NOTE: A deposit may also be required. The deposit amount will be based on Online Utility Credit Check and/or 2 times average bill for location. A Customer Service Representative will be in touch with you to get your Social Security Number to run a credit check.
METER NUMBER - IF AVAILABLE
ARE YOU BUYING, RENTING OR BUILDING A NEW PROPERTY?

BUYINGRENTINGBUILDING
WHAT IS THIS SERVICE FOR?

NEW CONSTRUCTIONTEMPORARY SERVICE IN ORDER TO BUILDEXISTING LOCATION
IS THERE A SECURITY LIGHT ON THE PROPERTY?

YESNO
IF YES, DO YOU WANT THE SECURITY LIGHT CONNECTED?

YESNO
WOULD YOU LIKE TO PARTICIPATE IN OPERATION ROUNDUP? (This program allows members to round their bill to the next dollar. That small amount of change goes to fund service projects - food banks, wheelchair ramp construction, youth programs - in the communities we serve. Contributions will be less than $12 per year.)

YESNO
HOW WOULD YOU LIKE YOUR BILL SENT TO YOU?

E-BILLSTANDARD BILLBOTH
Each year, you will have the opportunity to cast a vote in our Board of Directors Election. Would you like the ballot sent to you via email or mail? (If email, please be sure to provide the email address at the top of this form.)

EMAILMAIL
Would you like a traditional post-pay account or a prepay account?

PREPAYTRADITIONAL POST PAY
Please attach a photo of the front of your driver's license.

Browse Files

Cancelof
What is the best time to contact you? Monday - Friday, 8:30 AM - 4:00 PM
This application will be reviewed by Tri-County EMC's Customer Service Department. You will receive a call from Tri-County to complete the application process.
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