Application for Existing Residential Service

Please complete this application for existing residential service with Owen Electric Cooperative, Inc. (OEC).

(*) Required

Today's Date:  
Date Service is Desired:  *  
Type of Request:  
Applicant Information:
First Name:		   *
Last Name:   *
Middle Initial:  
Social Security Number:--  *
Employer:  

Billing Address:
Address where you will be receiving mail:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Address where service is to be connected:
*please include apt# or suite#, if applicable
Service Address:   *
Meter Number (if known):  
E-mail:  *
Confirm E-mail:  *
Contact Phone:--   *
Cell Phone:--  
Co Applicant Information:
Name:		 
Co Applicant SSN:-- 
Co Applicant Employer:  
Contact Phone:  
Email Address:  
Confirm Email Address:  

Online Portal:
We offer an online portal that can be used for viewing and paying bills, as well as managing other account options.  If you would like to create a portal login, please specify a password below.  Your password must be a combination of numeric and alpha characters. 
Internet Password:  
Confirm Internet Password:  
Password Hint:

Have you or co-applicant had service with OEC previously?    
Account Number:
Membership & Deposit Information:
A one-time membership fee of $25 is required to receive service from Owen Electric Cooperative. A security deposit may also be required (based on a routine credit check or previous credit history, if applicable). Deposit amounts are equal to 2/12ths of annual usage at the location. After your account is established, you will receive an email advising of the total amount due on your new account, including deposit amount, if required.


Outdoor Lights:
Is there an Outdoor Light at the service location?
(yes or no)		  *
If yes, would you like service to the Outdoor Light?
(yes or no)		  
If no, would you like an Outdoor Light installed?
(yes or no)		  
Do you rent or own at the service location?   *
Please select your preferred billing method:   *
 
An Owen Electric representative will contact you should there be questions in establishing your account. Otherwise, your application for service will be processed immediately. As a new member, you will receive a mail-out packet that includes form(s) for completion. These forms along with fees that may be required (membership fee and deposit, if applicable) must be received in our office within ten (10) days from the date your service was connected.

You will receive ten (10) days temporary service only. The forms and any fees due must be received by Owen Electric within this ten day period, or the service will be terminated.
I understand that checking this box and typing my name in the field provided below is my electronic signature.  
  Applicant Name:     *