SERVICE APPLICATION

WELCOME TO MidSouth Electric Co-op

ONLINE FORM INSTRUCTIONS

We look forward to serving you with your electric and water service needs. MidSouth Electric Co-op is committed to providing high quality service to every home and business in our community.

·      Please complete all the fields of the application and read the terms and conditions before submitting the application.  

·      Incomplete applications will not be processed.

·      Information on the application will be used to run a credit check to determine  your deposit.

ELECTRIC SERVICE MEMBERS
Before applying for service, CLICK HERE to view our Electric Service Area Map to ensure service is available in your area.

RESIDENTIAL MEMBERS – CLICK HERE for fees and deposit information.

·      Residential members can avoid a deposit and credit check by signing up for PAY-AS-YOU-GO. Click here for more information.

·      Members who pay a contribution in aid of construction line extension fee may be entitled to a refund (NEW CONSTRUCTION MEMBERS ONLY). Click Here to find out more.

COMMERCIAL MEMBERS – CLICK HERE for fees and deposit information.

WATER SERVICE MEMBERS
Before applying for service, CLICK HERE to view our Water Services Area Map to ensure service is available in your area.

WATER SERVICE MEMBERS – CLICK HERE for fee and deposit information.

For more information and contact information logon to https://midsouthelectric.com/

Notes: All fields with the asterisk (*) are required.  All requests for new service at an existing location have 5 to 7 business days to be completed.  New Services will not be connected on Holidays or weekends.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Type(s) of Service:      *
First Name:   *
Last Name:   *
SSN:--  *
Drivers License #:  *
License State:  
Birth Date:    
Employer:  
2. Do you need Area Lights at the location of service? (Type YES or NO)  *
3. What type of service is required? (SINGLE PHASE/THREE PHASE)  

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 street address where service is required:
Service Address:  
Service Type (Construction Required or Existing Service):   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--  
Busniess Phone:--   *
Spouses Name: 
Spouses SSN:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  
Spouses Drivers License #:  
Spouses Date of Birth:  
Spouses Email Address:  
Spouses Phone:  

Sign Up for Online Bill Pay

Our members have the flexibility of managing their account information online to pay their bill, update account information and more. To sign up for an Online account, please specify an Internet Password and Password Hint. 
Internet Password:  *
Confirm Internet Password:  
Password Hint:



2. If you prefer Regular Monthly Billing, please choose which Billing Cycle would best fit your needs? (Type CYCLE 1, CYCLE 2, CYCLE 3 or CYCLE 4)  
3. Which Bill Payment Option do you prefer? (Type PERSON, MAIL, PHONE, EPAY or DRAFT)
  *
 
ELECTRIC SERVICE AND WATER SERVICE APPLICANTS CHECK THE FOLLOWING BOX

ELECTRIC SERVICE APPLICANTS: I hereby completed this application and agree to purchase electric service from Mid-South Electric Cooperative Association upon the following terms and conditions.  I have read and understand the applicable Electric Service Agreement.  By checking this box, I agree to a credit check to determine deposit amount.  I understand that I will receive a bill for services, per the billing option selected on this application.  Pay-As-You-Go Service Agreement (For members that want to sign up for Pay-As-You-Go Service - residential electric members only). 

WATER SERVICE APPLCIANTS: I hereby completed this application and agree to purchase water service from Mid-South Electric Cooperative Association upon the following terms and conditions.  I have read and understand the applicable Water Service Agreement.  By checking this box, I agree to a credit check to determine deposit amount.  I understand that I will receive a bill for services, per the billing option selected on this application.

 

When the application has been submitted a Member Service Representative will call you to confirm the request for service. After the application has been processed, supporting documents delivered and any required fees paid, your request for service will be completed. Please contact us with any questions at 1-888-525-6677 or memberservices@mselectric.com
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *