Application for Membership & Electric Service

1Applicant Details

2Service Request

3Payments & Billing

4Confirmation

URL

This field is for validation purposes and should be left unchanged.

Applicant Details

Name(Required)

First Last

Phone Number(Required)

Social Security Number(Required)

Date of Birth (MM/DD/YYYY)(Required)

Month

Day

Year

Mailing Address / PO Box(Required)

Street Address Address Line 2 City State ZIP Code

Place of Employment(Required)

Photo ID(Required)

Drop files here or

Max. file size: 20 MB.

Do you have a co-applicant?(Required)

Yes

Co-Applicant Details

Co-Applicant Name

First Last

Phone Number

Social Security Number

Date of Birth (MM/DD/YYYY)

Month

Day

Year

Place of Employment

Co-Applicant Photo ID

Drop files here or

Max. file size: 20 MB.

Application for Membership in Natchez Trace Electric Power Association & For Standard Electrical Service

Service Type(Required)

Residential

General Power (Commercial)

The undersigned applicant(s) hereby makes application for membership and for standard electric service and agrees to pay for said service as measured by the Association's meter according to the applicable rate schedule.

Applicant(s) agrees to pay for said membership the sum of $10, to pay Association's standard Service Connection Fee(s), to make deposit or deposits, and in addition thereto pay such sum or sums as required in accordance with the Association's Policies, Rate Schedule(s), and Schedule of Rules and Regulations. Said membership and deposit are not transferable, and are refundable only when all amounts due Association by Applicant(s) are paid in full. Applicant(s) acknowledges his/her responsibility for and agrees to pay any amount due Association in excess of said deposits, which deposits may be applied against his/her account(s).

Applicant(s) agrees to permit authorized agents of Association free access to his/her premises for the purpose of constructing, inspecting, reading, repairing, maintaining or removing property of the Association.

To the extent he/she is legally able to do so, Applicant(s) agrees upon request and without compensation, to execute and deliver to Association grants of easement or right of way across lands owned by Applicant(s), in accordance with such reasonable terms and conditions as Association shall require. If construction or new facilities are required, Applicant(s) understands service cannot be provided until all necessary grants of easement or right of way across the lands involved have been acquired.

Association shall have the right, but shall not be obligated, to inspect Applicants installation before electric service is introduced, or at any later time, and reserves the right to reject any wiring or appliances not in accordance with Association's standards; but such inspection or failure to inspect or reject shall not be regarded as an insurance against defects in installation, wiring or appliances and shall not render Association liable or responsible for any loss or damage resulting from defect in the installation, wiring, or appliances, or from violation of Association's Schedule of Rules and Regulations or Policies, or from accidents which may occur upon Applicant's premises.

Applicant(s) agrees that this application is subject to Association's attached Schedule of Rules and Regulations, which are made a part of this application and agreement.

The Applicant(s) will comply with and be bound by the provisions of the Certificate of Incorporation, Bylaws and Policies of Association, and such Schedule of Rules and Regulations and Policies as may, from time to time, be adopted by Association and, upon acceptance of this application, subscribes to Association's publication, "Electro-Lines."

It is understood that this membership in Association and payment of all applicable fees and charges will enable me to secure standard electric service at Association's applicable rate at the following location and possibly, subsequently, at other locations within the service area of Association.

This application is for service at the following address, conditioned upon the availability of service lines:

Service Address(Required)

Same as previous

Street Address Address Line 2 City State ZIP Code

Construction Required?(Required)

Yes

Permanent or Temporary Service?(Required)

Permanent

Temporary

Is this a mobile home?(Required)

Yes

Trailer Registration Form

Please upload a completed copy of the Trailer Registration Form provided by your county tax assessor's office.

Drop files here or

Max. file size: 100 MB.

Own or Rent?(Required)

Own

Rent

Proof of Ownership/Lease(Required)

Please upload proof of ownership or a lease agreement. This is required for service. The membership application must be completed using the exact name listed on the property deed or rental agreement.

Drop files here or

Max. file size: 100 MB.

Payments & Billing

We offer many ways to pay and view your bill: Online (website or mobile app), automatic bank draft, phone, mail, in person. See our Billing & Payment Options page for additional details.

Bank Draft(Required)

Do you wish to enroll in bank draft and have your payment automatically deducted from your bank account? Choose Yes if you want to provide the information now. You can also sign up later using our customer portal or mobile app.

Yes

Bank Name(Required)

Routing Number(Required)

Account Number(Required)

Voided Check(Required)

Please attach a photo of a "voided" check.

Drop files here or

Accepted file types: jpg, gif, png, pdf, avif, webp, Max. file size: 100 MB.

Member Consent(Required)

The above bank will be authorized to honor such checks, which should be drawn in accordance with my signature below.

Enroll in Paperless Billing?(Required)

Receive a monthly notice sent directly to your email. Paperless billing is fast, easy, secure, and convenient. It also helps your cooperative save money and reduce waste.

Yes

Email(Required)

Member Consent(Required)

I agree to receive an e-bill statement and not a paper bill.

Warning of Danger

Association specifically warns Applicant(s) that it is extremely dangerous for any antenna to be erected or maintained on Applicant's premises in such position that it could by installation, moving, or falling come within 10 feet of an electric line. Applicant(s) is also specifically warned that it is extremely dangerous to work with any machinery, grain auger, well casing, metal roofing or siding, or other thing in such location that it can come within 10 feet of an electric line.

Warning of Danger Consent

Applicant(s) agrees that he/she will not so erect or maintain or permit to be erected or maintained any such antenna installation on his/her premises served with electricity by Association. Further, he/she will not work with or permit anyone to work with any such antenna, machinery, grain auger, well casing, metal roofing or siding, or other thing in such location on said premises.

Confirmation & Signature(s)

Rules & Regs Consent(Required)

Applicant(s) agrees to abide by the Schedule of Rules and Regulations. A copy of your membership application and our Rules and Regulations can be provided by request at any of our local offices and may also be viewed online. Schedule of Rules and Regulations(Required)

Applicant Consent(Required)

I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.(Required)

Applicant Signature (Full Name)(Required)

Co-Applicant Signature (Full Name)(Required)