Service Order Form

Please do not use this page to report outages or dangerous situations!

To place a service request or to request a brochure, complete form online and submit below.

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

Asterisked fields (*) are required fields

Service Order/Brochure Request Form

Name

Address

Address Cont.

City/Town

State/Province

ZIP/Postal Code

Day Time Phone Number

Evening Phone Number

E-mail

Service Requested

For Suspected Voltage Problems or Tree on the Line, PLEASE contact the Haywood EMC office at (828) 452-2281 or (800)-951-6088.

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:

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.

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