Preliminary Membership Application

Please provide us with the following information.

After completing the form, a Member Services Representative will contact you within 24 business hours.

Remember, we must speak with you to establish service.

First & Last name
New address where you will have electric service
Best daytime number
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
1 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.