MEMBERSHIP APPLICATON AGREEMENT AND SERVICE CONTRACT:
Thank you for requesting service with Mountain Electric Cooperative.  To request new service be connected, please complete the information below (This application can only be used for new membership applications).  A Member Service Representative will contact you within one business day to complete the application process or you will receive an automated email once your account has been officially created in our system.  If you have any questions regarding new service, please contact our office during normal business hours (423) 727-1800 or https://www.mountainelectric.com/contact/.  

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
First Name:		   *
Last Name:   *
Social Security No:--  *
Driver's License No:  *
License State:  
Birth Date:    
Employer:  
Cell Phone Carrier:  *

Mailing Address:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Physical 911 Address of Location
Service Address:   *
City, State:
(Additional Comments regarding location)		   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Work Phone:--   
Co Applicant Information:
Name:		 
Social Security No:-- 
Driver's License No:  
License State:  
Birth Date:    
Employer:  

Online Access:
We offer a portal for online bill payment and account management.  If you would like access to your account online, please create a password and password hint now for easy access to your account at https://www.mountainelectric.com/.  Please note passwords must be a combination of letters and numbers.
Internet Password:  
Confirm Internet Password:  

Existing Service:
Have you ever had service with Mountain EC?

    
Account Number:

Membership Fee:  
Connect Fee/Transfer:
*NC Residents subject to NC tax		  
Credit Assessment Fee:  

Would you like this to be a Prepay Account? (yes or no)  *
Is there an existing outdoor light at the location? (yes or no)  *
If yes, do you want to keep the Outdoor Light? (yes or no)
Note: There are monthly charges associated with this request.		  
Are you interested in Bank Draft? (yes or no)  *
Do you own or rent the service location?   *
Would you like to participate in MEC's Operation Pocket Change?
Operation Pocket Change is a voluntary round up program that assists worthy local organizations as well as fellow members who have fallen on hard times. Participating co op members volunteer to round up their monthly electric bills to the next whole dollar amount.		   *
Please select your preferred billing method:   *
 
Residential and Business Terms:
This application agrees to the terms and conditions that are stated in the Rules and Regulations, By-Laws and policies of the Cooperative which are in effect at the present time and which may change from time to time as adopted by the Cooperative. The applicant agrees to pay reasonable costs and attorney’s fees incurred by the Cooperative in the collection of any unpaid electric bills due to the Cooperative. The applicant also agrees to pay delinquent charges such as late payment charges, collection charges and return check charges as may be established by the Cooperative in regards to delinquent accounts. In addition, the applicant agrees to pay any recurring charges that may exist at the location for providing service to the premise.

Further, the applicant grants to the Cooperative, its successors and assigns, the right to enter upon, and to place, construct, repair, maintain, replace, or relocate thereon electrical distribution poles, lines, appurtenances, and other facilities, and to do all acts necessary in said construction, operation, maintenance, or repairing of said facilities at the sole discretion of the Cooperative. Necessary acts may include the cutting of all trees directly under any of the Cooperative’s lines, cutting or trimming all trees within the Cooperative’s 40’ right of way (20’ on either side of line), or removal of any obstacle that might become an object of interference in the construction, operation, maintenance or repairing of said electrical poles, lines, appurtenances, and other facilities. 

Further, the Cooperative’s employees shall have access to applicant’s premise at all reasonable times for the purpose of reading meters, testing, repairing, removing, or exchanging any or all equipment belonging to the Cooperative. 

Each party by affixing his/her signature below agrees that the above information is correct and agrees to the above stated terms and conditions and to accept full responsibility for the electric bill for this account. By signing the applicant agrees that if fees and other charges have been paid but service was not activated in a reasonable amount of time, the Cooperative reserves the right to void said application and contract at which time funds being held would be refunded to the applicant if service or parts of services are not rendered.

By signing this application the applicant authorizes the Cooperative to obtain credit information regarding the applicant from the trade references and credit reporting agencies. Based upon this information the Cooperative may require the applicant to make a deposit.

Prepay Terms:
By completing this form, I agree to the terms of the Pre-pay electric account program.  I understand that if my application is approved:

1.I will provide a prepayment reserve of $75.00 in order to obtain electric service from MEC, plus applicable fees.

2. Purchases can be made at any Mountain EC office or payment by phone using a debit/credit card.  MEC will attempt to send a daily balance and usage notice by text or by email.  I understand this will be the only notice that will be provided and if my account reaches a negative or if a check used for energy purchase is returned MEC will discontinue my electric service without any further notice, written or otherwise.

NOTE: MEC reserves the right to discontinue or alter the Pre-pay program at any time. 
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *