Harmon Electric Cooperative, Inc.

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Residential Service
(Service to building with Meter)

Home > Account Services > Establish New Service > Residential Service

Please fill out the following form to request service from Harmon Electric Association. This form is for establishing service at property WITH EXISTING ELECTRICAL SERVICE ONLY.

If you are building on or purchasing property that has not had electric service before, see the information about New Construction.

- Establish New Residential Service Application -

Name:
Social Security Number:	- -
Date of Birth:	- -

Address or Physical Location requiring electrical service
(P.O. Boxes are not Accepted)

Address:
City:
State:
Zip Code:
Meter Number:

Mailing Address
(if Different from Above)

Address:
City:
State:
Zip Code:
Home Phone:
Business Phone:
E-Mail Address:
Employer:
Requested Date of Service:	/ /
(Connection requests will be completed as early as the next working day pending rceipt of fees and deposit)

Phone Number where our Service Representative can contact you promptly to finalize your application between 7:30 a.m. and 4:30 p.m. Monday - Friday

Contact Number:

JOINT APPLICANT

Name:
Social Security Number::	- -
Date of Birth:	- -
Business Phone:
Employer:

Nearest Relative Not Living with Applicant

Name:
Relationship:
Address:
City:
State:
Zip Code:
Home Phone:

Required Fees, Deposits and Contracts

Membership Fee:
We require a $5 membership fee, which establishes you as a member-owner of Harmon Electric Association. This fee is credited to your account balance if you discontinue service with us. Once your application is acknowledged, you will be given the option to call and charge your membership fee to your credit card or mail a check to our office. Your membership will be activated when your membership fee is received.

Security Deposit:
We require new customers to post a security deposit equal to two months usage at your new location or $250 (whichever is greater). You may also charge your security deposit to your credit card or mail a check to our office.

Application Acknowledgement and Further Instructions:
Once you complete and submit this application, you will receive an acknowledgement that Harmon Electric received your application and instructions concerning your membership fee and security deposit.

By completing and submitting this application, the applicant hereby applies for one (1) membership in, and agrees to purchase central station electric energy from HARMON ELECTRIC ASSOCIATION, INC. upon these terms and conditions.