Application for Membership and New Service

Please complete the below application to request electric service from Central Electric.  Service Requests are processed from 8 a.m. to 5 p.m. Monday through Friday.  If you have any questions please contact our office at 919-774-4900 or 1-800-446-7752. 

If you are renting, buying or own your property, a rental or lease agreement, purchase agreement or proof of ownership is required.  In certain circumstances additional identification may be required.

Note: All fields with the asterisk (*) are required.  Incomplete applications will not be processed.  Information on this application will be used for the purpose of a credit check through Experian.  Notice: Central Electric will only run one credit check per service location.  Depending on the results of your credit check, you may be required to pay a deposit in full, prior to electric service being connected. 

(en espanol)


Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant First Name:   *
Applicant Last Name:   *
Applicant Middle Initial:  
Social Security #:-  -   *
Driver's License #:  *
License State:  
Birth Date:
"mm/dd/yyyy" format
 *  
Preferred method of communication?
(email or call)
 *

Billing Address: Direccion donde quiere recibir la factura:
Please enter the address where bills should be sent:
Por favor ingrese la direccion donde las facturas deben ser enviadas:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address: Direccion de servicio:
Please enter the street address where service is required:
Por favor ingrese la direccion de la calle donde se requiere servicio:
Service Address:  
Comments and/or Directions to New Construction:  
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -    *

Online Service:
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. Please note that the Internet password must be at least 4 characters in length and must include a combination of letters and numbers.

Como uno de nuestro servicios, ofrecemos la opcion de ver y pagar facturas por la internet. Si desea utilizer este servicio, puede especificar una contraseña. Tenga en cuenta que la contraseña debe tener al menos una combinación de 4 letras y números.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service:
Have you had service with us before?
Ha tenido servicio con nosotros antes? *please enter the first 5 digits of your account number only
    
Account Number:

Fees: Cargos

Please Note: Additional services in the same name will not have to pay an additional membership fee.

Membership Fee:    $5.00
In Office: $15.00
Out of office: $30.00

For Flex-Pay accounts (residential only), a minimum of $100.00 is required for initial service.

Para las cuentas de Flex-Pay (solo residenciales), se requiere un mínimo de $100.00 para iniciar servicio.

Membership Fee:    $5.00
Flex-pay connect fee: $30.00

This will leave the account with a $65.00 credit balance

Esto dejará la cuenta con un saldo de crédito de $65.00



What fuel source do you use for your heating and cooling?
(gas or electric)
 *
Are you renting or buying the home?   *
 
I have read and agree to the Service Rules & Regulations, Bylaws, and Flex pay Terms of Service (if applicable) of Central Electric. By submitting this application request, I also agree that a credit check will be submitted, to determine if a security deposit is required.

He leído y acepto las Reglas y Reglamentos de Servicio y Términos de Servicio de Flex Pay (si corresponde) de Central Electric. Al enviar esta solicitud, también acepto que se hara una verificación de crédito, para determinar si se requiere un depósito de seguridad.

Central Electric requires all information be submitted either by email, fax or in person. If you choose to submit any information in advance via email, fax or online, please be advised that the electronic transmission of personal identifying information (driver’s license number, Social Security number, or other identifying information) may be subject to inadvertent disclosure to third parties due to the nature of the technology. Any delivery of personal identifying information is at your own risk and no guarantee or warranty of privacy, express or implied, is given by Central Electric Membership Corporation. Central Electric will use commercially reasonable measures to protect information received or sent by Central Electric at your request. Central Electric does not use encrypted data to communicate with its customers and members.

Central Electric requiere que toda la información se envíe por correo electrónico, fax o en persona. Si decide enviar cualquier información por correo electrónico, fax o en línea, tenga en cuenta que la transmisión electrónica de información de identificación personal (número de licencia de conducir, número de Seguro Social o otra información de identificación) puede estar sujeta a la divulgación involuntaria a terceros debido a la naturaleza de la tecnología. Cualquier entrega de información de identificación personal es bajo su propio riesgo y no hay ninguna garantía o garantía de privacidad, expresa o implícita, dada por Central Electric Membership Corporation. Central Electric utilizará medidas come razonables para proteger la información recibida o enviada por Central Electric a petición suya. Central Electric no utiliza datos cifrados para comunicarse con sus clientes y miembros.

I understand that checking this box and typing my name in the field provided below is my electronic signature. By placing my name in the field area provided, I agree to the Service Rules & Regulations and Bylaws of CEMC.

Entiendo que marcar esta casilla y escribir mi nombre en el campo que se proporciona a continuación es mi firma electrónica. Al colocar mi nombre en el área de campo proporcionada, acepto las Reglas de Servicio y Estatutos de CEMC.

  Applicant Name: Nombre de solicitante:     *