Please complete this form to apply for electric service. Service requests are processed during normal business hours (Monday - Friday, 8 a.m. - 5 p.m.). If you have any questions regarding service, please feel free to contact our office 877-205-4736.

Note: All fields with the asterisk (*) are required. Incomplete applications will not be processed.


Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
First Name:
  *
Last Name:   *
Social Security Number:-  -   *
Driver's License Number:  
License State:  
Date of Birth:  *  
Employed By:  
Employer Street Address:  
Employer City, State:  
Employer Zip Code:  

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

Service Address:
Please provide the physical 911 address.
Service Address:  
Service Type (Construction Required or Existing Service):  
Name of the county in which your service is to be located?   *
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -    *
Employer Phone:-  -     
Spouse or Joint Applicant Information:
Name:
 
Social Security Number:-  -   
Driver's License Number:  
License State:  
Date of Birth:    
Employed By:  
Employer Phone:  

Online Access:
We offer a portal for online bill payment and account management. If you would like access to your account online, please create a password and password hint below. Please note passwords must be a combination of letters and numbers.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing/Previous Service:
Have you ever had service with Slash Pine EMC?
    
Account Number:
Fee & Deposit Information:
In addition to the $5.00 Membership Fee and the $25.00 Establishment Fee, a Security Deposit up to $500, based on your personal credit history, may also be required; refundable upon closing your account. Click Here for information on how you can waive the deposit by participating in our Pre-Pay Electric Service Program.  When your account is created in our system, you will receive and email including the total amount due on your new account.

Membership Fee:  
Processing Fee:  

Would you like this to be a Prepay Account?
(Indicate Yes or No)
 *
Would you like to rent a security light?
(Indicate Yes or No)
*If yes, one year agreement is required
 *
Landlord Name:  
Landlord Phone:  
Do you rent or own your home?   *
Please select your preferred Billing Method:   *
 
The undersigned applicant applies for membership in and agrees to purchase electric energy from Slash Pine Electric Membership Corporation upon the following terms and conditions.  The applicant(s) hereby apply for Slash Pine Electric Membership Corporation’s Pre-Pay Service Program.  Any additional account(s) or transfer of services under this membership may be enrolled into prepay billing and will be governed by the rules and guidelines as stated in this agreement, in addition to the Cooperative’s Service Rules and Regulations.  This agreement will remain in effect for a period of thirty (30) days after the date that the last prepay account under this membership is closed (if applicable). Prepay accounts agree to receive daily alerts and reminders via text and/or email.

I certify that everything I have stated in this application and on any attachments is correct. By signing below I authorize Slash Pine EMC to check my credit history status through the Online Utility Exchange, employment history, and to answer any other questions that Slash Pine EMC may have concerning my credit record with me for the sole purpose of determining my service security deposit. I understand by refusing to grant this authorization, I will pay the maximum deposit as set by the Board of Directors of the Cooperative.

The Cooperative does not guarantee continuous and uninterrupted electric service and will not be liable for loss or damages to any consumer’s equipment or property caused by any failure to supply electricity or by an interruption or reversal of the supply of electricity if due to any cause beyond the reasonable control of the Cooperative.

I, the applicant, understand the failure to provide true and correct information will result in electric service to either not be established and/or disconnected.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *