New Service Application

Please complete this application to apply for new service with Tri-County Electric Cooperative.  An identity verification and delinquency risk assessment will be performed to comply with the Federal Red Flag Rule and cooperative policy.

If you have any questions regarding setting up service, please feel free to contact our office at (580) 652-2418.

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


Today's Date:  
Date Service is Desired:  *  
Type of Request:  *
Applicant Information:
First Name:
  *
Last Name:   *
Middle Initial:  
SSN:-  -   *

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

Service Address:
Please enter the physical address where service is required:
(A P.O. Box is not acceptable because it cannot be used to locate service)
Service Address:   *
Service Type (Construction Required or Existing Service):  *
If applicable, directions to Service Address:  
E-mail:  *
Confirm E-mail:  *
Contact Information:
Primary Phone:
-  -    *
Cell Phone:-  -   
Work Phone:-  -     
Joint Applicant: (Spouse Only)
Full Name:
 
SSN (Required):-  -   

Online Access:
As one of our services, we offer an online application for viewing and paying bills. If you would like to use this service, you can specify an Internet Password and Password Hint at this time. Please note that the Internet Password must be at least 4 characters in length and is case sensitive.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service:
Have you ever had service with Tri-County Electric before?
    
Account Number:

Deposit Information:
Depending upon the results of a delinquency risk assessment, you may be required to pay a deposit before electric service will be connected. When your account is created, a representative will contact you with the total amount due on your new account, including the deposit amount, if applicable.



Additional Information:
Are you interested in receiving text alerts?
(yes or no)
 
Are you interested in receiving email alerts?
(yes or no)
 
Would you like to enroll in our Pay As You Go prepaid plan to avoid deposits and collection fees?
(yes or no)
 
Are you interested in enrolling in AutoPay to automatically deduct your monthly electric bill from your bank or credit card account?
(yes or no)
 
Are you interested in our Levelized billing option to receive a more consistent monthly bill?
(yes or no)
 
Please select your preferred Billing Method:  *
 
Please read carefully: I have read and agree to the application terms, the cooperative's bylaws and the rules and regulations of service. By submitting this application request, I also agree that a delinquency risk and identity verification assessment may be submitted to determine if a security deposit is required. I understand that I may be asked to provide two forms of identification in person prior to the connection of service. I understand that Tri-County Electric Cooperative is a member-owned utility and that by submitting this application I am a member of the cooperative.