Application for Membership and Electric Service

To establish electric service with Northcentral Electric Cooperative, please complete the application below. Please note, we do not guarantee same day request. All fees and deposits must be paid prior to service being connected.

After your account has been created, you will received an email from customerservice@northcentralelectric.com with required documentation and payment amounts needed to complete the application process.

A prepay account can be created for $125.00. ($50.00 membership, $50.00 Credit and $25.00 service charge). To request Prepay, please indicate "yes" in the field below.

If you have any questions regarding setting up service, please contact our office at 800-325-8925 during office hours, Monday through Friday 8:00 a.m. - 5:00 p.m.

Note: All fields with asterisk (*) are required.

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

Billing Address
Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address
Please enter the address where service is required:
Service Address:  
Service Type (Construction Required or Existing Service):   *
Directions to the Service Location:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--  
Work Phone:--   *
Co Applicant's Name: 
Social Security Number:-- 
Driver's License:  
License State:  
Birth Date:    
Employer:  
Home Phone:  
Cell Phone:  
Work Phone:  
Email Address:  

Online Access 
As a convenience to our customers, we provide an online application for viewing and paying bills.  If you would like to use this service, in the section provided below, please specify an Internet Password and Password Hint for online account access.  For security purposes, please specify a password that is at least 4 characters in length.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service 
Have you ever had service with us before?    

Account Number:

Fee & Deposit Information 
A Membership Fee of $50.00 is due with the Application for Service. In addition, a security deposit and hook up fee may also be required. The deposit amount, if applicable, is determined based on a credit check. Once your account has been established, you will receive an email with the balance due on your account, including deposit amount and hook up fee, if applicable 

Interested in waiving your deposit?  Click here to get more information on our Prepay Program (PayMyWay).

Membership Fee:  

Are you interested in Prepay?
(yes/no)		  *
Do you own or rent at this location?:   *
Please select your preferred billing method:   *
 
Checking this box confirms an agreement that the above specified Applicant herby applies for membership in, and agrees to purchase energy from Northcentral Electric Cooperative (hereinafter called the "Cooperative") upon the following Terms and Conditions. I give Northcentral Electric Cooperative express consent to send SMS text alerts and emails to inform me of account activity including account balance and usage information. If your mobile number or email address changes, it is important that you contact Northcentral Electric Cooperative to update the information. This will minimize interruption in your alerts and reminders service.
I understand that checking this box and typing my name in the field provided below is my electronic signature. 
  Applicant Name:     *