|
Name |
*
|
|
*
|
|
|
First
|
MI
|
Last
|
|
SSN (Last 4 digits)
|
*
|
|
|
Service Address |
*
|
| City
|
*
State
*
Zip
*
|
|
|
*
|
|
|
If Renting |
|
Name of Owner
|
Phone
|
|
|
|
Billing Address |
*
|
| City
|
*
State
*
Zip
*
|
|
Home Phone
|
*
|
Best time to call
*
|
|
Business Phone
|
|
Cell Phone
|
|
Email |
|
I would like to recieve a.. |
|
|
Employer |
*
Phone
|
|
Year of Birth
|
*
|
|
Civil Status
|
|
|
Spouse Name |
|
|
Spouse SSN (Last 4 digits) |
|
|
Spouse's Employer |
Phone
|
|
Spouse's Mailing Address |
|
| City
|
State
Zip
|
|
Name of nearest relative not living in household
|
*
|
|
Relation
|
*
|
Phone
*
|
|
*
|
|
|
Lot
|
Block
Subdivision
|
| City
|
State
Zip
|
|
Name of person service previously listed in
|
|
|
Is there an outside security light at this location?
|
*
|
|
If yes, do you want to continue outside security light service?
|
|
|
Small change changes lives through Carroll EMC's Operation Round Up program. Your monthly electric bill will be rounded up to the next full dollar with the small change being donated to the CEMC Foundation. Show your support.
|
|
|
Get $15 just for agreeing to have a Smart Saver Switch installed on your air-conditioning unit
and/or heat pump. Plus you will receive a discount of $2.50 per month during CEMC's summer
rates.
|
*
|
|
Green Power helps preserve our environment by using landfill gas to generate electricity. To show your support for a safer, cleaner place to live, purchase one (1) block of 150 kwh for $5 per month.
|
*
|
Bylaw Terms and Conditions
Service Rules and Regulations
|
|
Desired Start Date
|
*
*
*
|
I have read the Bylaws & Service Rules & Regulations
|
|
|
|