Application for Membership In and Service Contract

Please complete this application to apply for new service. All new applicants are required to pay a membership fee and a connect fee. These fees may be billed or the applicant may be required to pay before connection of service, pending a credit check. Based on the results of a credit check, a security deposit of $100.00 or $200.00 will be required. If you have any questions regarding setting up new service, please contact customer service during normal business hours at (478) 552-2577, (800) 552-2577.

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:--  *
Drivers License Number:  *
License State:  
Date of Birth:  *  

Billing Address:
Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Street Address:
Please enter the address where service is required.
Service Address:   *
County:   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Busniess Phone:--   
Spouse Information: (if applicable)
Spouse Name:
Social Security Number:-- 
Spouse Driver's License:  
Spouse License State:  
Spouse Birth Date:    
Spouse Employer:  
I have read and agree to the below Construction Agreement. (indicate yes in field area provided)  *
Do you want to receive account alerts & reminders through text, email or push notification? (please indicate yes or no)
*Cell Phone will be required to utilize this feature*

Overhead/Underground Electrical Service Construction Agreement

Owner agrees to assume all responsibility for repairs, replacement, re-grassing, etc. of water lines, driveways, roadways, underground utilities, and septic tanks or other property upon completion of construction/excavation, overhead or underground, for electric service provided by the Cooperative (provided reasonable care is exercised by the Cooperative.)

Due to reasons beyond the control of the Cooperative, (i.e. bad weather, power interruption, unscheduled maintenance, inability to place equipment due to wet ground or previous schedulings obligations) Washington EMC cannot make commitments with regard to when line construction may begin on any project.

Online Access
We offer a variety of online services that our customers may use through our website. As one of our services, we provide an online application for viewing and paying bills. Please specify an Internet Password and Password Hint at this time.

***Please use this Online Access to sign up for Account Alerts & Reminders, Bank Draft or Credit Card Draft.***

Internet Password:  *
Confirm Internet Password:  
Password Hint:

New Contruction
Is this New Construction?

Account Number:

Fee & Deposit Information
All new applicants are required to pay a $5.00 membership fee and a $15.00 connect fee. These fees may be billed or the applicant may be required to pay before connection of service, pending a credit check. If you would like to request same day service, please contact our office. Note, a $50.00 connect fee will be applied for same day service requests. Based on the results of a credit check, a security deposit of $100.00 or $200.00 will be required. When your account is created, you will receive an email with the total amount due on your new account, including the deposit amount.

Membership Fee:  

Is there an existing security light at this location?  *
Would you like the security light still connected?
(enter "N/A" if not applicable)
Is this a Hunting Club or Recreational Account?  *
Landlord Name, if applicable:  
Do you Own or Rent this Location?   *
Please select preferred Billing Method:   *
The applicant (the "Applicant") hereby applies for membership in WASHINGTON ELECTRIC MEMBERSHIP CORPORTATION, a Corporation (the "Cooperative"), and the Applicant and the Cooperative have read and agree to the following terms.

Application for Membership In and Service Contract With
Washington Electric Membership Corporation

1. Applicant has paid a $5.00 membership fee with this application. If this Application is not accepted by the Cooperative, the fee will be returned to the Applicant.

2. Applicant agrees to comply with and be bound by the provisions of the Cooperative's Articles of Incorporation, Bylaws, rates, tariffs, this Application, Service Rules and Regulations and other reasonable rules and regulations as from time to time adopted by the Cooperative, including without limitation the following obligations of the Applicant and rights of the Cooperative.

A. To take and purchase from the Cooperative all central station electric energy, capacity and electric distribution service (collectively, "Electric Service") from the Cooperative for the premises for which Electric Service is sought in this Application;

B. To execute and deliver to the Cooperative grants of easement or right-of way over, on and under the premises to which Electric Service is to be provided, for the construction, operation, maintenance or relocation of the Cooperatives facilities, lines and equipment, including without limitation the right to ingress and egress as well as clear and remove vegetation or other threats or interferences with the electric system;

C. To pay the full price of Electric Service at the applicable rate, regardless if the charges invoiced by the Cooperative;

D. To grant to the Cooperative a security interest in and permit the Cooperative to offset debts owed by me to the Cooperative against all amounts owed me that are held by the Cooperative;

E. To have control and responsibility for all electric wiring, apparatus, equipment and facilities on the premises beyond the Cooperative's attachment point, and to indemnify the Cooperative, its employees, agents and contractors against death, injury, loss or damage resulting from defect in or improper use or maintenance of Applicant's premises, wiring, apparatus, equipment and facilities receiving or utilizing electric energy.

3. Applicant acknowledges that the Applicant will be automatically enrolled in a program called Operation RoundUp whereby the monthly bill for Electric Service will be rounded up so that there is added to each bill an amount of cents sufficient to make the bill equal to the next highest dollar amount, unless the Applicant opts out of the program by giving the Cooperative written or verbal notice. Proceeds from Operation RoundUp go to the Washington Electric Foundation, which makes charitable donations within the Cooperative's service area.

4. The acceptance of this Application by the Cooperative constitutes a contract between the Applicant and the Cooperative, which shall be for one (1) year from the date service is made available to the Applicant, and thereafter continue until cancelled by written notice given by either party to the other. The Applicant acknowledges receipt of a copy of the Bylaws.

5. Applicant agrees to a credit check by the Cooperative for purposes of information verification and establishing required deposit level.

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