Application for Membership and Service

Please complete this application to apply for new service. If you have any questions as you complete the application, please contact Member Services during normal business hours Monday through Friday at (770) 832-3552. 

All fields with the asterisk (*) are required.

Please allow 2 – 3 hours for processing all orders.  Applications are processed Monday through Friday between 8 am and 4:30 pm EST. 

Type of Request:
Using the dropdown menu below, please select whether you are applying for residential traditional, residential PrePay or commercial service (if service will be in your business name). 

With traditional billing, you are billed monthly for your energy usage (post-consumption). For more information on traditional billing, visit https://carrollemc.com/traditional.  

With PrePay billing, you pay for your energy usage before you use it (pre-consumption). For more information on PrePay billing, visit https://carrollemc.com/prepay.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
Legal First Name:		   *
Legal Last Name:   *
Legal Middle Initial:  
SSN:-  -   *
Birth Date:    
Employer:  
Who else is authorized on this account?  
Last 4 digits of SSN for authorized person(s):  

Mailing Address:
Please enter the address where bills should be sent. Include Apt #, Suite # or Building # to line one, if applicable.
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:

Service Address:   *
Service Type (Construction Required or Existing Service):   *
Comments:  
E-mail:  *
Confirm E-mail:  *
Phone Numbers Associated with Account:
Primary Phone:		-  -    *
Cell Phone:-  -   
Other Phone:-  -     
Spouse Information:
Legal Name:		 
SSN:-  -   
Birth Date:    
Employer:  

*ALERT! Please verify address and phone number before submitting your application. Some browsers will automatically fill in addresses and personal information.

Online Access:
As one of our services, we provide an online application for viewing and paying bills. If you would like to use this service, please specify an Internet Password and Password Hint at this time. Please note that the Internet Password must be at least four characters in length.
Internet Password:  *
Confirm Internet Password:  
Password Hint:

Existing Service:
Have you ever had service with us before?
(Please provide only numbers preceding the dash. For example, "12345-001" would need to be entered as "12345".)    

Account Number:

Fee & Deposit Information:
All new applicants are required to pay a $15 membership fee and a $20 account service charge. 

If you select Traditional billing as your preferred service, these fees can be billed or paid up front. Based on the results of a credit check, a security deposit may also be required. 

If you select PrePay billing as your preferred service, you will be required to pay a minimum of $65 up front before connection of service. This includes the $15 membership fee and a $20 account service charge in addition to a $30 credit to go towards your daily usage.

When your account is created, you will receive an e-mail with the total amount due on your new account, including the deposit amount (if applicable). 

Membership Fee:  
Account Service Charge:  

Is there an outside yard light at this location?
(indicate Yes, No or I Don't Know):		  *
If yes, do you want to continue service to this outdoor light?
(indicate Yes or No):		  
Do you want to receive account alerts by text, phone, email or all?  
Please confirm service Address (street name and number):  *
Please select preferred Billing Method:   *
 
I accept and comply with the Bylaw Terms & Conditions, Service Rules & Regulations, Residential Conditions of Membership, Commercial Conditions of Membership and Prepay Conditions of Membership (if applicable). By checking this box, I am electronically signing my application for service. I understand that a credit/identity check will be performed on all applicants. Any past due amounts to Carroll EMC must be paid in full before service can be established. If you've never had service with us before, you may be required to apply in person at one of our offices. Applicant shall be enrolled in Operation Round Up. To opt out of this program contact member.services@carrollemc.com . Applications received after 4:30pm may not be processed until the next business day.

 
I understand that checking this box and typing my name in the field provided below is my electronic signature. Your signature gives prior express written consent to receive automated telephone calls and text messages (if applicable) from the Cooperative to any number you have provided.
  Applicant Name:     *