Application for Electric Service

Electric Meter To apply for electric service, complete the form online and submit below.

This form will begin the process of applying for electric service. Once the form is submitted, our member-services team will reach out on next steps of getting your electric service connected.

(Please use the Tab key to move from field to field. Using the Enter key with some browsers will submit your form.)

ALL FIELDS MUST BE COMPLETED, Thank you!

Apply for Electric Service

Name

Service Address

Address Cont.

City/Town

State/Province

ZIP/Postal Code

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

SSN

(Last 4 Digits)

Driver's License #

Day Time Phone Number

Evening Phone Number

E-mail

Spouse Name

Spouse's SSN

(Last 4 Digits)

If you are interested in signing up for any of these services, check the appropriate box below (click on the item for more info)

Equal Payment Plan

NC GreenPower Contribution

Helping Each Member Cope

Handi Pay Plan

Security Lighting

Other Comments:

With submission of this application, the Applicant agrees to the following:

Agrees to pay bills upon receipt of statement
Understands failure to receive bill does not excuse Applicant from paying
Understands failure to meet obligations will result in disconnection

A Haywood EMC Customer Service Representative will contact you during normal business hours, 8:00 a.m. to 5:00 p.m. Monday thru Friday. After approval by a Co-Op Customer Service Representative, this application must be signed and notarized.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

CUSTOMER SERVICE: 1.800.951.6088

Application for Electric Service

This form will begin the process of applying for electric service. Once the form is submitted, our member-services team will reach out on next steps of getting your electric service connected.