New Service Application

Please complete the below application to request electric service from Four County Electric Corporation. Service Requests are processed from 8 a.m. to 5 p.m. Monday through Friday. We need a minimum of 72 hours notice before service can be established. If you have any questions, or need service immediately, please contact 1-888-368-7289

Note: All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Customer Information:
First Name:
Last Name:   *
Middle Initial:  
Social Security Number:--  *
Driver's License #:  
License State:  
Birth Date:
(mm/dd/yyyy format)

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

Service Address:
Please enter the physical 911 address where service is required:
Service Address:  
Service Type (Construction Required or Existing Service):   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Work Phone:--   
Co Applicant Information:
Social Security Number:-- 
Driver's License #:  
License State:  
Birth Date:
(mm/dd/yyyy format)

Online Access:
We offer a portal and mobile app for ebill, online bill payment and account management. If you would like to access your account online, please create a password and password hint below.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service:
Have you ever had service with us before?
Account Number:

Fee and Deposit Information:
When your account is created in our system, you will receive an email including the total amount due on your new account.

Wish to waive your deposit? Click here for more information on Prepay billing!

Would you like this to be a Prepay Account?
(indicate yes or no)
Please select your preferred Billing Method:   *
Check here to agree to the following terms: 

By submitting this request, I, the above named individual (hereinafter called applicant) hereby apply for membership in and agree to purchase all electric energy for the requirements of the premises for which this application is made from Four County Electric Membership Corporation (hereinafter called Cooperative).The information given herein is to my knowledge correct.

The applicant for membership or the Member should bear in mind that the Membership Agreement provides that the Member will abide by all Bylaws of the Cooperative and all Policies, known as Service Rules and Regulations, adopted by the Board of Trustees of the Cooperative. Various Bylaw provisions and policies apply to many different specific problem areas. A copy of the Member Policies is available upon request.

I agree to a credit check to determine deposit amount, if applicable.

By signing below, you give Four County EMC consent to contact you via phone, send emails and SMS text alerts to inform you of account activity including account balance and usage information. If your contact information changes, it is important that you contact Four County EMC to request the information be updated. Account alert and notification preferences can be managed online or via our mobile app.
  Applicant Name:     *