Application for Service

Please complete this application to request electric service from Union Power Cooperative. Completing a new application is not required if you have had an active Union Power account within the past 12 months. Call Customer Service at 800-922-6840, option 4, and let them know you are a member and would like to start service at another address. Service requests are processed from 8 a.m. to 5 p.m., Monday through Friday. We need at least 72 hours' notice before establishing service. If you have questions or need service immediately, contact your local Union Power office.

Additional Requirements

If you own your property, proof of ownership (Offer to Purchase, Purchase Agreement, or Closing Statement) is required. If you are renting or leasing your property, a rental agreement is required before service can be established. You may email documents to new.service@union-power.com. In some circumstances, additional identification may be required. A soft credit check is performed for the applicant (and spouse, if applicable) using the SSN or ITIN provided to determine if a security deposit is required. A connection charge will be added to your first bill.

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

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information
First Name:		   *
Last Name:   *
Middle Initial:  
SSN or ITIN:--  *
License/Govt ID #:  *
License/Govt ID State:   *
Date of Birth:    
Current Home Address:  *
City, State & Zip:  *

New Mailing Address
Please enter the address where bills should be sent:

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

New Service Address
Enter the street address where new service is requested, whether existing service or new construction.
Do not include city, state or zip code.
Service Address:   *
Service Type (Construction Required or Existing Service):   *
Parcel/Lot Number, Property Location Information and/or Additional Comments:

Applicant Contact Information
  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Work Phone:--   
Spouse Information
Name:		 
SSN or ITIN:-- 
License/Govt ID #:  
License/Govt ID State:  
Date of Birth:    
Home Phone:  
Cell Phone:  
Work Phone:  
Email:  

Connection Charge:  

What type of structure?
(House, Mobile Home, Condo/Apt, Barn, Well, Shop)		  *
Landlord's Name:
*enter n/a if not applicable		  *
Landlord's Phone:  
Do you own or rent at the service address?

   *
Would you like to enroll in Operation Round Up®?

Operation Round Up® rounds up your monthly bill to the next whole dollar amount. All Operation Round Up® funds are held in trust and distributed through the Union Power Charitable Foundation (UPCF) and stay right here in our local communities.		   *

How would you like to receive your monthly electric bill?		   *
 
I understand that by checking this box I have read and agree to the terms and conditions stated below.

Union Electric Membership Corporation (the “Cooperative”) agrees to provide electric service for the undersigned applicant. Upon signing, the applicant confirms all information provided is truthful and accurate; agrees to be bound and comply with all provisions of the Cooperative’s Certificate of Incorporation, Bylaws, Service Rules and Regulations, and all other Membership Obligations as defined therein; and agrees to pay for service received. This executed document serves as a Certificate of Membership and is filed electronically at the Cooperative.
I understand that checking this box and typing my name in the field below represents my electronic signature.
  Applicant Name:     *