Application for Service

Please complete the below application to request electric service from Union Power Cooperative.  Service Requests are processed from 8 a.m. to 5 p.m. Monday through Friday.  We need a minimum of 72 hours notice before service can be established.  If you have any questions, or need service immediately, please contact your local Union Power office at 704-289-3145 or 1-800-922-6840 (en español).

 

If you are renting or leasing your property, a rental agreement is required and service will not be processed until the documentation is received.  Please fax documentation to 704-485-4725. In certain circumstances additional identification may be required.

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 Middle Initial:  
Social Security #:-  -   *
Driver's License #:  *
Birth Date:  *
Current Street Address:  *
City, State & Zip:  *

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

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

New Service Address
Please enter the street address where new service is required:
*(Do not include city, state or zip code information)

Service Address:   *
Service Type (Construction Required or Existing Service):   *
Comments and/or Directions to New Construction:  
E-mail:  *
Confirm E-mail:  *
New Home Phone:-  -    *
Cell Phone:-  -   
Employer Phone:-  -     
Co Applicant Name: 
Social Security #:-  -   
What fuel source do you use for water heating? (Gas or Electric)  
What fuel source do you use to heat your home? (Gas or Electric)  
What fuel source does your stove use? (Gas or Electric)  
What fuel source does your dryer use? (Gas or Electric)  
Do you have an Outdoor Light?  *
Do you want the Outdoor Light connected?  

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 (en español).

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service

Have you ever had service with us before?

    
Account Number:
Fee & Deposit Information

The below shown $25 connection fee will be charged to your first bill. To determine if a security deposit is required, we will run a credit check using your social security number or federal tax ID number. If you do not wish to have your credit checked, a maximum deposit will be required before your application is processed. If a deposit is required, it will need to be paid before service is established. (en español)


Connection Fee:  

Are you interested in Bank Draft?  
What type of home is it? (House, Mobile Home or Condo/Apartment)  *
Landlord Name:
*enter n/a if not applicable
 *
Landlord's Phone:  
Do you own or rent at the service location?  *
GO GREEN! Please select your preferred billing method: (Paper, Email or Both)  *
 
I accept and agree to the terms and conditions of the below disclaimer.

DISCLAIMER: UNION POWER COOPERATIVE AGREES TO PROVIDE ELECTRICAL UTILITY SERVICE TO SIGNED CUSTOMER. UPON SIGNING, APPLICANT AND CO-APPLICANT CONFIRM ALL INFORMATION PROVIDED HEREIN IS TRUTHFUL AND ACCURATE, AND ALSO AGREE TO COMPLY WITH UNION POWER COOPERATIVE'S SERVICE RULES AND REGULATIONS, AND TO PROMPTLY PAY FOR SERVICES RECEIVED. UPON ACCEPTANCE BY CHECKING THE BOX BELOW, THIS FORM WILL SERVE AS A CERTIFICATE OF MEMBERSHIP AND WILL BE FILED ELECTRONICALLY AT UNION POWER COOPERATIVE (en español).