ONLINE APPLICATION

TAP INTO THE POWER

We've made it as easy as possible

for you to become a member in our co-op.

MEMBER INFORMATION

Full Name:

Birth Date:

SS/FED ID:

Driver's License:

Email:

Home Phone:

Work Phone:

Cell Phone:

Billing Address:

City:

State:

Zip:

Employer:

Employer Address:

Government Issued ID:

LOCATION INFORMATION

SPOUSE / OTHER INFO

Spouse / Other?

Yes

Other Authorized User?

Yes

EMERGENCY CONTACT

Name:

Relationship:

Phone:

Address:

City:

State:

Zip:

ADDITIONAL INFO

Have You Been A Member of This Cooperative Before?

Yes

I (hereinafter called the “Applicant”) have read and agree to the Service Application Guidelines and the Member By-Laws and hereby apply for membership and agree to purchase electric energy from Southern Pine Electric.

ONLINE APPLICATION

TAP INTO THE POWER

Don't Want To Apply Online?

MEMBER INFORMATION

LOCATION INFORMATION

Structure Type:

Do You Own or Rent?

Location Type:

Business Account Type:

Business Type:

SPOUSE / OTHER INFO

Spouse / Other?

Other Authorized User?

Authority By Power of Attorney?

EMERGENCY CONTACT

ADDITIONAL INFO

Have You Been A Member of This Cooperative Before?

Do You Owe Outstanding Debts to Southern Pine?

TAYLORSVILLE HEADQUARTERS

AND DISTRICT OFFICE