Service Application

Please complete this application to apply for new service. All new members are required to pay membership, application and connection fees. Based on the results of a credit check, a security deposit may also be required. An Advance Pay option is available for residential members who do not wish to pay a deposit. In addition to the membership, application and connection fees, Advance Pay members are required to have a $50.00 credit balance. 

If you have any questions regarding setting up service, please contact our office during normal business hours. All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
First Name:   *
Last Name:   *
Middle Initial:  
SSN:--  *
Driver's License:  
License State:  
Birth Date:
*must be 18 years old		  *  
Employer:  

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

Service Address
Please enter the street address where service is required:
Service Address:   *
Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Spouse Name: 
Spouse SSN:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  

Online Access
We offer a variety of online services that our members may use through our website. As one of our services, we provide an online portal where members can view/pay bills and manage their account preferences. Please note passwords are required to be a minimum of 5 characters and must be a combination of uppercase letters, lowercase letters, numbers, and symbols (!@#$%^&*).
Internet Password:  *
Confirm Internet Password:  
Password Hint:


Membership Fee:  
Connect Fee:  
Application Fee:  

Would you like this to be a Advance Pay Account? (yes or no)  *
Do you own or rent at this service location?   *
 
Residential and Commercial Members:
I warrant that the above information for the purpose of obtaining electric service is true and complete. I also agree to receive and pay for said service in accordance with applicable rate schedules and service regulations of the Cooperative. It is agreed that the Cooperative reserves the right to discontinue service in case of any violations of terms or for falsification of any of the above information. The applicant hereby applies for membership in, and agrees to purchase electric energy from HORRY ELECTRIC COOPERATIVE, INC. upon the following conditions.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *