Application for Service

Please complete this form to apply for new Residential, Commercial or ElectPay service. Click here for more information on Residential, Commercial and ElectPay services types. If you have any questions regarding setting up service, please email us. All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
First Name:   *
Last Name:   *
Middle Initial:  
Social Security Number:-  -   *
License State:  
Birth Date:    

Billing Address
Please enter the address where bills should be sent:

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

Service Address:  
Service Type (Construction Required or Existing Service):   *
Meter Number:  
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -   
Busniess Phone:-  -     
Co Applicant Name: 
Social Security Number:-  -   
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  

Online Access
We offer a variety of online services that our customers may use through our website. As one of our services, we provide an online application for viewing and paying bills. Please specify an Internet Password and Password Hint at this time.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service
Have you ever had service with us before?

Account Number:

Fee & Deposit Information
All applicants are required to pay a $5.00 membership fee. Residential and Commercial applicants may be required to pay a security deposit, based on results of a credit check, before service is connected. ElectPay applicants are not required to pay a security deposit but will be required to establish a credit balance to be applied to future energy use. When your account is created, you will receive an email with the total amount due on your new account, including the deposit amount, if applicable.

Membership Fee:  
Connect Fee  

Would you like to recieve notifications via email, text or both?:  *
Please select preferred Billing Method:   *
By checking this box I, the applicant, hereby apply for membership in, and agree to purchase electric energy from Kiamichi Electric Cooperative upon the terms and conditions.