Application For Membership

To start residential or commercial/business service, complete the application below.  If you have any questions regarding new service please send an email to  

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

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:   *
Birth Date:    

Mailing Address:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Physical/911 address of service requested:
Service Address:   *
Service Type (Construction Required or Existing Service):   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Additional Authorized Person: (if any)
Social Security Number:-- 
Driver's License Number:  
License State:  
Birth Date:    

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 had service with us before?
Account Number:
Fee/Deposit Information:
A security deposit will be required when you request service for any given location. This deposit will be determined by your credit from our utility credit reporting agency.
Credit ratings will be divided in 3 categories:
•Good--$ 10.00



Once your account has been officially created in our system, you will receive a new account information email, including a total amount due on your new account, also including deposit amount.

Membership Fee:  

Do you rent or own the service location?   *
Please select preferred Billing Method:   *
The undersigned, hereinafter called the "Applicant", hereby applies for membership and agrees to purchase electric energy from Three Notch Electric Membership Corporation, hereinafter call the "Cooperative", under the following terms and conditions.  I have also read, understand and agree to the Service Rules and Regulations.

I authorize Three Notch Electric Membership Corporation to obtain a copy of my report from a credit reporting agency. I understand that Three Notch Electric Membership Corporation reserves the right to require me to pay an additional cash deposit should I have an adverse Credit Rating Score. 

I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *