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 Prepaid Metering. 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 or questions please contact us at 936-825-5100 or memberservices@mselectric.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:      *
Applicant Information:
First Name:		   *
Last Name:   *
SSN:--  *
Drivers License #:  *
License State:  
Birth Date:
*mm/dd/yyyy format		    
Employer:  
Do you need Outdoor Lights at the location of service?
(Type YES or NO)		  *

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:--   *
Business Phone:--   
Spouse Information:
Name:		 
SSN:-- 
Driver's License:  
License State:  
Birth Date:
*mm/dd/yyyy format		    
Employer:  
Email Address:  
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. Create a password for your online access.
Internet Password:  *
Confirm Internet Password:  

Fees:
A Membership Fee is it not required if:

      *You have an existing active membership

      *The location is water only


BILLING INFORMATION:
MidSouth Electric offers two billing options Regular monthly billing Or Prepaid Metering. Which Billing Option do you prefer? (REGULAR or PPM)		  *
If you prefer Regular Monthly Billing, please choose which Billing Cycle would best fit your needs? (CYCLE 1, CYCLE 2, CYCLE 3 or CYCLE 4)  
Operation Round Up:
As a voluntary contributor to Operation Round Up, you choose to have your monthly electric bill rounded up to the next highest dollar amount. The average Operation Round Up contribution is just fifty cents per month or $6 per year but that small amount makes a huge difference in the lives that it touches. Funds collected through the Operation Round Up program allows MidSouth Charitable Foundation to provide scholarships for graduating seniors and make donations to local organizations that assist the community through utility and other crisis assistance throughout the year. Would you like to participate in Operation Round Up?		  
 
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.  Prepaid Metering Service Agreement (For members that want to sign up for Prepaid Service - residential electric members only). 

WATER SERVICE APPLICANTS: 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.

 

When the application has been submitted a Member Service Representative will call you to confirm the request for service within 5-7 business days. If immediate service is requested upon submitting the application please contact us at 936-825-5100. Once 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 936-825-5100, toll free 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:     *