Business/Organization Name First Address(Required) Billing Address Address 2 City/Town State/Province AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP/Postal Code Email Address(Required) Business phone with Area Code(Required)Accounts Payable Contact(Required) Federal Tax ID(Required)Accounts Payable Phone(Required)HomeOfficeCellPhoneExt:Date Of Transfer If Existing ServiceMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Subdivision Name Lot Block Physical/911 Address Same As Billing Address?(Required) Yes No Address Physical/911 Address Address 2 City/Town State/Province AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP/Postal Code Is This An Existing Service(Required) Yes No Name Of Previous Occupant First Last Meter NumberApplicant agrees to become a member and comply with and be bound by the Cooperative’s articles of incorporation, bylaws and tariffs, including rate schedules and service rules. Rates may be changed by the Cooperative’s board of directors in the manner provided by law. Member shall grant to Cooperative written easement(s) satisfactory to the Cooperative that are necessary for a cooperative purpose including providing electric service to Member or other members or applicants for the Cooperative’s service. Your signature indicates this business/organization’s acceptance of all responsibility, liabilities and assets for the requested services. Access is required for meter reading and line maintenance purposes. Member/consumer agrees to provide access for such purposes and to allow Fannin Electric Co-op. to install a lock if there is or ever shall be a locked gate at this location. All Applicants subject to ID verification and credit report review. False, inaccurate or incomplete information will invalidate the application until discrepancies are resolved. Please allow up to 3 business days from the initial scheduled date for connection of an existing service location. You Will Be Contacted by Phone or E-Mail for Total Balance of Fees Due (which May Include a Security Deposit And/or Connection Fees), Your Account Number and Payment Methods. Once Payment Is Made, Please Report Your Transaction Id# for Scheduling of Services.Drivers License(Required)Accepted file types: gif, jpg, png, svg, Max. file size: 10 MB.Signature of Authorized Representative Agent(Required) Printed Name(Required) First Last Title(Required) DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time Hours : Minutes AM PM AM/PM Remarks CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
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