Service Application

APPLICATION FOR ELECTRIC SERVICE
Today's Date*

MonthDayYear
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.*

YesNo
Is the electricity currently on?*

YesNoI don't know
Type of Service*
Please specify type of residence*
Is the home all-electric?*

YesNoI don't know
Please specify the type of service*

Shop/Shed/BarnIrrigationSmall Commercial (requiring less than 100 KW)Large Commercial (requiring greater than 100 KW)GateElectric FenceOther
Pump Horse Power*
Name*

First NameMiddle/Maiden NameLast Name
Business Name
Type of Applicant*
Landlord's Name
Landlord's Phone Number

Area CodePhone Number
Move In Date or Service Needed By Date*

MonthDayYear
CUSTOMER MAILING ADDRESS
Address*

Street Address

Street Address Line 2

CityState

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

Area CodePhone Number
Phone Type*

CellHomeWorkOther
Secondary Phone Number

Area CodePhone Number
SSN or EIN*
Date of Birth*

MonthDayYear
Drivers Lic. or Government Issued ID No.*
State Issued*
Expiration Date*

MonthDayYear
Employer*
Marital Status*
Does anyone over the age of 18 live with you?*

YesNo
Spouse's Name*

First NameMiddel/Maiden NameLast Name
Spouse's SSN*
Spouse's Date of Birth*

MonthDayYear
Spouse's Phone Number*

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

First NameMiddel/Maiden NameLast Name
Cohabitant's SSN*
Cohabitant's Date of Birth*

MonthDayYear
Cohabitant's Phone Number*

Area CodePhone 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?*

YesNo
REQUIRED UPLOADS

We require a valid picture ID for all applicants listed on this application. You may upload permits or any other applicable documentation.
Valid Driver's License or Gvmt Issued ID Card*

Browse Files

Cancelof
Deed/Lease

Browse Files

Cancelof
Building/Sewer Permits

Browse Files

Cancelof
Other Documents

Browse Files

Cancelof
**Deposits for service that is being transferred from another party must be paid before the end-of-service date for the outgoing party or service will be interrupted. All other deposits must be paid within 48 hours or the order for service will be cancelled.**
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?*

YesNo
Would you like information on paying your monthly bill by Bank Draft?*

YesNo
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: