Application for Service/Membership 
and Agreement

Please complete the form below to request new service.  Service cannot be connected on weekends or holidays.  If you have any questions, please feel free to contact our office during normal business hours Local: 903-683-2248 Toll Free: 800-992-4280.

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:  
Social Security No:--  *
Driver's License No.:  *
License State:  
Birth Date:    
Employer:  
Requested Voltage:
(indicate 1 Phase straight 480, 1 Phase 120/240, 1 Phase 240/480, 3 Phase 120/208, 3 Phase 120/240, 3 Phase 240/480 or 3 Phase 277/480		  
Main Breaker Rating: (AMPS)  
Gas:
(indicate yes or no)		  *
Desired Service Type:
(indicate Overhead or Underground):		  
Motor Greater Than 50 HP:
(indicate Yes or No):		  

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

Service Address:
Please provide the 911 address to be connected.
Service Address:   *
Service Type (Construction Required or Existing Service):   *
Existing Meter Number:  
City, State and Zip
General driving directions:		  
E-mail:  *
Confirm E-mail:  *
Cell Phone:--   *
Work Phone:--   *
Spouse: 
Social Security No:-- 
Driver's License No.:  
License State:  
Birth Date:    
Employer:  
Email:  
Phone:  
Cell Phone:  
Would you like this to be a Joint Membership?
(indicate yes, no or N/A)		  *
List any adult person(s) living at the service location:
(if none, type NONE)		  *
Nearest Neighbor:  

Online Account Access:
If you would like to manage your account online, including the capability to view and pay bills, please create a password below. Make sure your password includes both numeric and alphanumeric characters and is at least 8 characters in length.
Password:  
Confirm Internet Password:  
Password Hint:

Existing Service:
Have you had service with us before?
    
Account Number:
Fee & Deposit Information:
A membership fee is required from all applicants. Based on the results of a credit check, a deposit may also be required. Once your account is created in our system, you will receive an email with the total amount due on your new account, including deposit (if applicable).

Outdoor Light Option:
*Residential: If you choose to add one or more Outdoor Lights to your account, you will be billed a monthly base charge $10.74 per light. Additional fees may apply if light is not already on location.  

*Commercial: If you choose to add one or more Outdoor Lights to your account, you will be billed a monthly base charge $19.09 per light. Additional fees may apply if light is not already on location.


Would you like an Outdoor Light?
(yes or no)		  *
If YES, what size*?
(Residential or Commercial)		  
Are you interested in internet service provided by CCECA?
(yes or no)		  *
Is Property inside City Limits?
(yes or no)		  *
If so, what City?  
Property Owner:  *
Status at Service Location:   *
Please select preferred Billing Method:   *
 
The undersigned “Applicant” submits this application to be a member of Cherokee County Electric Cooperative Association (“Cooperative”) and hereby consents/agrees to be a “Member” of the Cooperative and purchase Electric Service from the Cooperative.  Applicant hereby agrees to the following terms and conditions as an Applicant for Membership and Electric Service and as a Member of the Cooperative. Applicant hereby certifies that the information provided herein is true and correct and acknowledges that he/she was given a copy of, or has access to, via website, the Cooperative’s Bylaws and New Member Information Packet.

Applicant will be responsible for locating and visibly marking/exposing all private underground utilities (including but not limited to water, sewer, telephone and gas) prior to the construction of electric facilities by the Cooperative. Any damages to unmarked underground utilities by the Cooperative will be at the owner’s expense and responsibility to repair.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *