Service Application

If you would like to establish new service with Tombigbee Electric Cooperative, please complete the below application form. Once your application has been processed in our system, you will receive an email including your new account number and total amount due on the new account. A Customer Service Representative will contact you for any additional information required to process your request.

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


Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant First Name:   *
Applicant Last Name:   *
Social Security #:--  *
Driver's License #:  *
License State:  
Birth Date:    
Employer:  

Billing 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. If there is an existing meter, please provide that meter number.
Service Address:  
Meter#:  
Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--  
Busniess Phone:--   
Spouse or Joint Tenant:
While it is not required that there be a spouse or joint tenant on your account, we will only speak with those listed on this application about your account.		 
Social Security #:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  

Online Access:
We offer a variety of online services that can be used through our website. As one of our services, we offer an online system for viewing and paying bills. Please specify an internet password and password hint to login to our online payment system.
Internet Password:  *
Confirm Internet Password:  
Password Hint:

Service History:
Are you a current or former member of Tombigbee Electric Cooperative?    
Account Number:
Fee and Deposit Information:
New applicants are required to pay a $5.00 membership fee. Based on the results of a credit check, a deposit may also be required. Once your request has been processed in our system, you will receive an email with the total amount due on your new account, including deposit, if applicable.

Membership Fee:  

Do you Own or Rent this location?   *
Preferred Billing Method:   *
 
BY CHECKING THIS BOX, THE UNDERSIGNED (HEREINAFTER CALLED THE "APPLICANT") HEREBY APPLIES FOR MEMBERSHIP IN AND AGREES TO PURCHASE ENERGY FROM TOMBIGBEE ELECTRIC COOPERATIVE, INC. (HEREINAFTER CALLED THE "COOPERATIVE") UPON THE FOLLOWING TERMS AND CONDITIONS. APPLICANT REPRESNTS THAT NEITHER APPLICANT NOR SPOUSE NOR ANY OTHER RESIDENT IN THE HOUSEHOLD OWES TOMBIGBEE ELECTRIC COOPERATIVE, INC A DELINQUENT BILL, ANY MISREPRESENTATION HEREIN SHALL BE GROUNDS TO DISCONTINUE SERVICE.