Online Web Form

Apply for Service - Online Application

Please complete this application to apply for new service. A confirmation email will be sent to you along with the service agreement within 2 business days of application submission. To complete the application process, return the service agreement along with your valid government issued picture id and pay any applicable fees required. A deposit may be required based on the results of your credit check or your previous payment history with Jefferson Energy Cooperative. By submitting this online application, you authorize Jefferson Energy Cooperative to perform a credit check, if necessary, as part of the application process. All members are required to pay a membership fee and connect fee. All fees must be paid before service is connected. If you have any questions regarding setting up new service, please contact our Member Services Department during normal busines hours at 706-547-2167.

Note: Online service requests are processed from 8 a.m. to 5 p.m. (Monday - Friday) excluding holidays a maximum of 30 days in advance.

All fields with the asterisk (*) are required.

Today's Date:	Today's Date: Invalid Date Format.
Date Service is Desired:	* Invalid date format.
Type of Request:	*

Applicant Information: First Name:	*
Last Name:	*
Middle Initial:	*
Social Security #:	-- *
Date of Birth:	* Invalid date format.
Employer:

Are you transferring service from one Jefferson Energy Cooperative location to another?	*
If you are transferring service, please enter your current service address or account number.

Mailing Address:
Please enter the address where you receive mail

Street Address/P.O. Box:	*
City:	*
State:	*
Zip Code:	*Invalid Zip Code format.

Service Address:
Please enter the address where service is required

Check here if same as Mailing Address

Service Address:

County?

E-mail:	*Invalid E-mail format.
Confirm E-mail:	*Invalid E-mail format.

Contact Information: Home Phone:	-- *
Cell Phone:	-- *

Cell Phone Provider:
New Construction Questions: Only answer the following 2 questions if new construction: 1.For new construction, how would you like service ran? (overhead, underground, undecided)
2.New Construction Type: (temp pole, permanent service) *Please note there is a $100 fee to run service to a temp pole.

Online Access:
As a convenience to our members, we provide an online portal and mobile app for viewing/paying bills and account management, including the sign up for various alerts and reminders.

Fee & Deposit Information:
A Membership Fee and Connect Fee are due with the Application for Service. More information regarding Fees can be found on our website. In addition, a refundable security deposit may also be required. For Residential accounts, the deposit amount, if applicable, is determined by a credit check or by existing credit history on a current or previous JEC account.

Once your account is created in our system, you will receive an email including information on how to set up your online account and other important information regarding your new account.

Connect Fee:

Would you like this to be a Prepay Account?	*
Would you like to receive Alerts & Reminders?	*
Indicate your preferred delivery method(s): (Text, Email and/or Voice Call) *You may choose more than one. Standard message and data rates may apply.
Please select your preferred Billing Method:

Terms and Conditions Printable Version

1. To comply with and be bound by the provisions of the Bylaws and Rules and Regulations now in effect and as may from time to time be adopted by the Cooperative.
2. To purchase from the Cooperative all central station electric energy used on the premise described on the application and to pay at least the minimum monthly charge specified in the applicable rate for your service, as well as any service charges or fees as may be adopted by the Cooperative from time to time.
3. To permit the Cooperative, after termination of service, to transfer all meter deposits, membership fee, and account balances to any active account I may have.
4. At the request of the Cooperative I will, if an owner of an interest in the premises to be served, grant to the Cooperative the necessary easements and rights to construct, operate, maintain and repair its lines and all equipment connected or used in connection therewith upon, along, across, over and under the premises described on the application and roads, streets, and highways adjoining said premises and will execute and deliver to the Cooperative any grant or instrument which the Cooperative shall deem necessary or convenient for all or any of said purpose.

Checking this box confirms an agreement that the above specified applicant is requesting service with Jefferson Energy Cooperative (the Cooperative) for the location as noted above. The applicant understands the Cooperative Bylaws and New Member Information Packet, including information on Cooperative programs and policies. Furthermore, the applicant has read and agrees to the above terms and conditions.

*By applying for electrical service you are giving Jefferson Energy Cooperative permission to contact you through the phone number and email provided regarding your electrical service. Your information will only be used for matters related to your electrical service with Jefferson Energy Cooperative.

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

Name: *

Service Address:
Latitude:
Longitude: