Residential Service Application Service Address(Required) Physical Address of Service Location 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 Addition Lot Block Mailing address for bill statement same as service location?(Required) Yes No Mailing Address Mailing address for bill statement 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 Main ApplicantName(Required) First Last Social Security Number(Required)Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Driver’s license/State(Required) Email Address(Required) Business PhoneHome/Primary Phone(Required)Cell Phone(Required)Drivers License(Required)Accepted file types: gif, jpg, png, svg, Max. file size: 20 MB.Main Applicant Signature(Required) Printed Name(Required) First Last DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time Hours : Minutes AM PM AM/PM Do you have a co-applicant?(Required) Yes No Co-ApplicantName First Last Co-Applicant Social Security Number(Required)Co-Applicant Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Co-Applicant Driver’s license/State(Required) Co-Applicant Email Address Co-Applicant Business PhoneCo-Applicant Home/Primary PhoneCo-Applicant Cell PhoneCo-Applicant Drivers License(Required)Accepted file types: gif, jpg, png, svg, Max. file size: 10 MB.Co-Applicant Signature(Required) Co-Applicant Printed Name First Last Co-Applicant DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Co-Applicant Time Hours : Minutes AM PM AM/PM Additional QuestionsIs there already a meter(s) at this location?(Required) Yes No Name of Previous Occupant First Last Date of Transfer(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Meter Number(Required)Applicant 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. Access is required for inspection and line maintenance purposes. Member/Consumer agrees to provide access for all utility purposes. Member/Consumer agrees 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.Terms of Agreement(Required)Agreement By clicking “I agree” or otherwise electronically submitting this application, you affirm that you agree with the terms hereof and that you are executing this application and intending to attach your electronic signature to it. Upon acceptance by the Cooperative, your submitted application will constitute a contract under Texas law. I agree to the terms of serviceIs this for new construction? Yes No New ServicesHave you already been in contact with a staking technician?(Required) Yes No Staking Technician Name(Required)-Select-Tom FoxJustin WhiteBrian WilsonRemarks CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
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