Application For Service


This application may be used for establishing an electric service connection as a new member, or as an existing member, you are able to request additional service under a separate meter.  If you currently hold a valid membership in the Cooperative, should the membership account become inactive at some future date, the active service account may be considered as a membership account.

NOTE: All fields indicated with a red * are required.  After completing this form and submitting the request, you will receive an e-mail
acknowledging your request for service.  You must select the link provided in the confirmation e-mail to activate your request.  Service
will not be connected until the request has been confirmed.


Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant First Name:   *
Applicant Last Name:   *
Applicant Middle Initial:  
Applicant SSN:-  -   *
Driver's License #:  *
Nationality:  
Applicant's Employer:  *
Employer Address:  

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

Please enter the street address where service is required:
Service Address:   *
Service Type (Construction Required or Existing Service):   *
If applicable, directions to new construction:  
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -   
Work Phone:-  -     *
Co Applicant Name: 
Co Applicant SSN:-  -   
Co Applicant Employer:  
Employer Address:  
Employer Phone:  

As one of our services, we provide an online application for viewing and paying bills. If you'd like to use this service, you can specify an Internet Password and Password Hint at this time. The Internet Password must be at least 4 characters in length.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Have you ever had service with us before?    
Account Number:
The following estimated fees and charges may be applied to your account:

Membership Fee:  
Deposit:  
Connect Fee:  

Name of Relative Not Living With You:  
Relative's Address:  
Relative's Phone:  
Name of Former Utility From Which You Received Service:  
Former Utility Address:  
Applicant's Former Address:  
 
Check here to agree to the following terms: 

By submitting this request, I, the above named individual (hereinafter called applicant) hereby apply for membership in and agree to purchase all electric energy for the requirements of the premises for which this application is made from Central Alabama Electric Cooperative (hereinafter called Cooperative). The information given herein is to my knowledge correct. 

The applicant for membership or the Member should bear in mind that the Membership Agreement provides that the Member will abide by all Bylaws of the Cooperative and all Policies, known as Service Rules and Regulations, adopted by the Board of Trustees of the Cooperative. Various Bylaw provisions and policies apply to many different specific problem areas. A copy of the Member Policies is available upon request.