C&L Electric Cooperative

Transfer/Add*

I want to transfer my existing service to a new location

I want to ADD an additional meter/service to my existing account

Please Specify

Requested Disconnect Date*

Service Location/Physical Address
(Street, City, State, Zip)*

Street Address

City

State

Zip Code

Requested Start Date*

C&L Account #*

Applicant Name*

Billing Address for NEW service*

Street Address

City

State

Zip Code

Primary Phone*

Additional Phone

Work Phone*

Email Address*

Social Security Number*

ID#
(Driver's License, State ID, Military ID, Passport or I551)*

Date of Birth*

Place of Employment*

Previous Address

Street Address

City

State

Zip Code

Add Co-Applicant

Yes No

Co-Applicant's Name*

Social Security Number*

ID#
(Driver’s License, State ID, Military ID, Passport or I551)*

Date of Birth*

Primary Phone*

Additional Phone

Place of Employment*

Work Phone*

Email Address*

I am a(n)*

Owner

Tenant

Please Specify

Landlord's Name*

Phone*

If there is a security light at this location, would you like to keep it?

Yes No

Upload required documentation (i.e. - Driver’s License, Lease agreements, proof of ownership, letter of credit, W-9)*

(pdf, docx, jpg, jpeg, png)

Mark the boxes below if your account should be marked as:

Age 65 or older

Handicapped (Doctor’s certification required)

Please Specify

Application for Change of Service

The acceptance of this application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, and the contract for electric service shall continue in force from the date service is made available by the Cooperative to the Applicant, and thereafter until cancelled by notice given by either party to the other. A $50.00 fee is required to transfer service or add an additional meter.

Everything I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether it is approved. You are authorized to check my credit and to answer questions about your credit experience with me.

C&L Electric Cooperative will make every effort to disconnect and connect the account within (5) business days.

Applicant's Signature
(Type your name)*

Co-Applicant's Signature
(Type your name)

Service Change Form

Request a change to your service

Application for Change of Service