Application for Membership

An Application for Membership In and For Electric Service is required from all Members.  The below application can be used to apply for Residential or Commercial service.  If you have any questions, please feel free to contact our office at 252-209-2236 or 800-433-2236 and one of our customer service representatives will assist you.   

Note: All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant First Name:   *
Applicant Last Name:   *
Applicant SSN:-  -   
License State:   *
Birth Date:  *  
Employer:   *
Nationality  *

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):   *
Meter Number:  
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 Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  

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.
Internet Password:  *
Confirm Internet Password:  
Password Hint:

Have you ever had service with us before?    
Account Number:
Each Service is required to pay Roanoke Electric Cooperative the sum of $10.00 as a meter deposit. Other deposits and membership fees may apply.

Other Deposit:  
Connect Charge:  
Sales Tax:  

Roanoke Electric Cooperative provides assistance to many area organizations through its member funded Operation Round Up program. As a member you're signed up to have your electric bill rounded up to the next highest even dollar to support the program. If you don't want to participate in this program, please select No from the dropdown box.  
I hereby apply for electric service in accordance with the Terms and Conditions of this application. By submitting this application request, I also agree that a credit check may be submitted, if necessary, to determine if a security deposit is required. A one time $5.00 membership fee applies.