Service Application

APPLICATION FOR ELECTRIC SERVICE
Today's Date *

Month Day Year
Property Address *
Is this a new service location?New service means there has never been electric service at this location or service has been permanently removed from the location. *

Yes No
Is the electricity currently on? *

Yes No I don't know
Type of Service *
Please specify type of residence *
Is the home all-electric? *

Yes No I don't know
Please specify the type of service *

Shop/Shed/Barn Irrigation Small Commercial (requiring less than 100 KW) Large Commercial (requiring greater than 100 KW) Gate Electric Fence
Pump Horse Power *
Name *

First Name Middle/Maiden Name Last Name
Business Name
Type of Applicant *
Landlord's Name
Landlord's Phone Number

Area Code Phone Number
Move In Date or Service Needed By Date *

Month Day Year
CUSTOMER MAILING ADDRESS
Address *

Street Address

Street Address Line 2

City State

Zip Code
Email *
example@example.com
Primary Phone Number *

Area Code Phone Number
Phone Type *

Cell Home Work
Secondary Phone Number

Area Code Phone Number
SSN or EIN *
Date of Birth *

Month Day Year
Drivers Lic. or Government Issued ID No. *
State Issued *
Expiration Date *

Month Day Year
Employer *
Marital Status *
Does anyone over the age of 18 live with you? *

Yes No
Spouse's Name *

First Name Middel/Maiden Name Last Name
Spouse's SSN *
Spouse's Date of Birth *

Month Day Year
Spouse's Phone Number *

Area Code Phone Number
Spouse's Email
example@example.com
Spouse's Drivers Lic. or Government Issued ID No. *
Spouse's Employer
Cohabitant's Name *

First Name Middel/Maiden Name Last Name
Cohabitant's SSN *
Cohabitant's Date of Birth *

Month Day Year
Cohabitant's Phone Number *

Area Code Phone Number
Cohabitant's Email
example@example.com
Cohabitant's Drivers Lic. or Government Issued ID No. *
Cohabitant's Employer
OPERATION ROUNDUP

Round Up makes it easy to donate to those in need right here at home. When you enroll in the Round Up program, your bill is rounded up to the next nearest dollar. For example, if your bill is $62.38, the amount will be rounded up to $63.00. The 62 cents added to your bill will go into a trust fund managed by a separate independent board made up of community-minded volunteers from the seven parishes we serve. The money is used to purchase goods or services for individuals or non-profit organizations in need. You can always opt in or out of this program on the SmartHub app or by calling our office.
Enroll in Operation RoundUp? *

Yes No
REQUIRED UPLOADS

We require a valid picture ID for all applicants listed on this application. You may upload permits or any other applicable documentation.
Government Issued ID *

Browse Files

Cancel of
Deed/Lease

Browse Files

Cancel of
Building/Sewer Permits

Browse Files

Cancel of
Other Documents

Browse Files

Cancel of
Determination of Deposit:

Residential deposits are either $100, $200, or $300 dependent upon a utility credit check. A customer service representative will contact you to let you know how much your deposit will be. Alternatively, you may elect to enroll in our $martPay billing option which does not require a deposit because you pay for electricity before you use it. You must complete the $martPay agreement if you wish to enroll. You may elect to enroll in $martPay now or at any time.
Enroll in $martPay? *

Yes No
Would you like information on paying your monthly bill by Bank Draft? *

Yes No
Determination of Deposit for Non-Residential Service:

A customer service representative will contact you regarding a deposit, if one is required.
Membership and Other Fees:

All members of Northeast Louisiana Power Cooperative, Inc., must pay a one-time membership fee of $10. If you are already a member, you will not be responsible for another membership fee. Additionally, there may be other fees assessed including, but not limited to, aid-in-construction costs, temporary service fees, and squeeze-on fees.
Applicant's Signature *

Clear
Should be Empty:

APPLICATION FOR ELECTRIC SERVICE

CUSTOMER MAILING ADDRESS

OPERATION ROUNDUP

REQUIRED UPLOADS

Determination of Deposit:

Determination of Deposit for Non-Residential Service:

Membership and Other Fees: