APPLICATION FOR MEMBERSHIP AND ELECTRIC SERVICE

Please complete this application to apply for new service. With this information, we will be able to set up your new account(s). If you have any questions about your upcoming service, please do not hesitate to call 800.369.2111.

All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant First Name:   *
Applicant Last Name:   *
Applicant Middle Initial:   *
SSN#:--  *
Driver's License #:  *
License State:  
DOB:  *  
Place of Employment:  
Payment Type:
(Traditional or Prepay)		  *

Billing Address:
Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please enter the street address where service is required:
Service Address:   *
Service Description:   *
E-mail:  *
Confirm E-mail:  *
Telephone:--   *
Cell Phone:--  
Work Phone:--   
Joint Membership (Co Applicant):
Name:		 
SSN:-- 
Driver's License #:  
License State:  
DOB:    
Place of Employment:  

Online Access:
We offer a variety of online services that our customers may use through our website. As one of our services, we provide an online application for viewing and paying bills. Please specify an Internet Password and Password Hint at this time.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Fee & Deposit Information:
All applicants are required to pay a $5.00 membership fee and $25.00 Service Charge before service is connected. Deposit amount is determined based on 2 times the highest bill at the location. A credit check may also be required. When your account is created, you will receive an email with the total amount due on your new account, including the deposit amount.

Membership Fee:  

Will you be residing on the premises? (yes/no)  *
Bill Existing Yard Light? (yes/no)  *
List any other user of electric service at this location:
(over 18 years of age)		  *
Initial you have read & agree to Right of Way Contract  *
Initial you have read & agree to Service Line Construction  *
Do you rent or own the service location?   *
Please select preferred Billing Method:   *
 
Residential and Business Terms:
By checking this box, I agree both the Applicant and Co-Applicant apply for membership and agree to purchase electric power and energy from the Cooperative and to be bound by and comply with all of the provisions of the Cooperative's Charter (including Articles of Conversion) and Bylaws, and all rules, regulations, rate classifications and rate schedules established pursuant thereto, as all the same now exist or may hereafter be adopted or amended. Appllcant(s) agrees to make payment of such fees and to make such deposits as may be required by the Cooperative. Applicant(s) further agree(s) to pay the indebtedness for services rendered and in the event of any past due amount agrees to pay all reasonable expenses of collection including court costs and attoney fees. Applicant(s) authorizes TCEMC to contact a credit bureau to obtain credit information for exclusive use by TCEMC. This information will be used to determine your deposit requirement or to obtain information to collect a past due amount. Per Section 1.08 of the Bylaws, each member shall make available to the Cooperative a suitable site, as determined by the Cooperative, whereon to place the Cooperative's physical facilities for the furnishing and metering of electric service, and shall permit the Cooperative's authorized employees, agents and independent contractors to have safe access thereto for meter reading and bill collecting and inspection, maintenance, replacement, relocation, repair or disconnection of such facilities at all reasonable times. The Applicant(s) certifies that the answers set forth in this application are true and correct.

Pre-Pay Terms:
By completing this form, I am applying for Tri-County Electric’s Pre-Pay Electric Account Program.  I understand that if my application is approved:

1. I will provide a $50.00 pre-payment reserve in order to obtain electric service from Tri-County Electric.

2. Purchases can be made at any Tri-County Electric office or payment by phone using a debit/credit card in any amount.  Tri-County will attempt to send a daily balance and usage notice by text or by e-mail. I understand that this is the only notice that will be provided and that if my account reaches a negative or if a check used for energy purchase is returned, Tri-County will discontinue my electric service without any further notice, written or otherwise.

3. When applicable, fifty percent of all pre-pay purchases will be applied to existing debt.

NOTE: Tri-County Electric reserves the right to discontinue or alter the pre-pay program at any time.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *