Application for Service

Please complete this form to apply for new Residential, Commercial or ElectPay service. Click here for more information on Residential, Commercial and ElectPay services types. 

Once this application has been submitted, please text or email photo IDs for applicant and co-applicant to newconnects@kiamichielectric.org or use the upload feature available when this form is submitted.  

If you have any questions regarding setting up service, please email us. All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
First Name:   *
Last Name:   *
Middle Initial:  
Social Security Number:--  *
DL#:  
License State:  
Birth Date:    
Employer:  
Cell Phone Carrier:  *

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

Service Address:  
Service Type (Construction Required or Existing Service):   *
Meter #:
The meter # will be 7 to 9 digits and is usually located by the smaller bar code at the top.		  *
Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--  
Busniess Phone:--   
Co Applicant Name: 
Co Applicant SSN:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  
Electronic Signature: I understand that typing my name in the field provided is my electronic signature. *Required if Co Applicant  

Online Access
We offer a variety of online services that our customers may use through our website. As one of our services, we provide an online application for viewing and paying bills. Please specify an Internet Password and Password Hint at this time.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service
Have you ever had service with us before?    

Account Number:

Fee & Deposit Information

All applicants are required to pay a $5.00 membership fee. Residential and Commercial applicants may be required to pay a security deposit, based on results of a credit check, before service is connected. ElectPay applicants are not required to pay a security deposit but will be required to establish a credit balance to be applied to future energy use. When your account is created, you will receive an email with the total amount due on your new account, including the deposit amount, if applicable.

Click here for more information on how you can waive your deposit with an ElectPay Prepaid Account.

Membership Fee:  
Connect Fee  

Would you like this to be an ElectPay Prepaid Account?
(indicate yes or no)		  *
If yes, please indicate Low Balance Threshold amount:
*The prepaid system will start notifying you when the amount reaches this balance		  
Would you like to receive notifications via email, text or both?  *
If this location has a security light do you want it activated?
(indicate yes or no)		  *
Do you own or rent the service location?  *
If this is a location that you do not own, please enter landlord name:  
Participate in Operation Round Up Charitable Outreach program?   *
Please select preferred Billing Method:   *
 
By checking this box I, the applicant, hereby apply for membership in, and agree to purchase electric energy from Kiamichi Electric Cooperative upon the terms and conditions.

Once this application has been submitted, text or email photo IDs for applicant and co-applicant to newconnects@kiamichielectric.org.  
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *