Application for Service and Membership

Please complete this application to apply for new service and membership with North Arkansas Electric Cooperative.  All new applicants are required to pay a membership fee before service is connected. Deposits are based on good payment history with an existing North Arkansas Electric account or, if new to the area, a letter of credit from another electric utility for the past 12 months. Letter of credit can be faxed to (870) 257-1219 in Ash Flat, (870) 508-5824 in Mountain Home or (870) 895-6279 in Salem. Residential Deposits are $180.00 and Commercial Deposits will vary. Total amount due may be required before service is connected.

If you have any questions regarding setting up service, please feel free to contact our office at (870) 944-2191 in Ash Flat, (870) 425-2141 in Mountain Home or (870) 895-3221 in Salem.

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

Today's Date:  
Date Service is Desired:  *  
Type of Request:  *
First Name:   *
Last Name:   *
Social Security Number:-  -   *
Driver's License Number:  
Employer:  
Employer Street Address:  
City, State:  
Zip Code:  

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 service is required. If no physical address is available, please type "N/A" in the field area provided.

Service Address:   *
Service Type (Construction Required or Existing Service):  *
Comments/Directions to Property:  
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -   
Work Phone:-  -     
Spouse Name: 
Spouse Social Security Number:-  -   

Online Access
We offer a varity of online services that our customers may use through our website.  As one of our services, we provide an online system 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
A $25.00 Membership Fee will is required for new service. If service is not currently at the location, a $50.00 connect fee will be accessed. In addition, a Deposit may also be required. Deposits are based on good payment history with an existing North Arkansas Electric account or, if new to the area, credit history from another electric utility for the past 12 months. Residential Deposits are $180.00 and Commercial Deposits will vary. When your account is created, you will receive an email with the total amount due on your new account, including deposit amount, if applicable.  Total amount due may be required before service is connected.


Membership Fee:  

Name of Landlord:
(if you are a tenant at this account location)
 
Name of Tenant:
(if you are the landlord)
 
Do you own this property?  *
Please select a preferred Billing Method: 
 
The applicant(s), whose name(s) appears above, applies to the North Arkansas Electric Cooperative, Inc., of Salem, Arkansas for electric service to be supplied, at a nominal voltage of 120 / 240 volts, at the location herein described and, upon request, at any other location to which he may move within the area served by the cooperative. The applicant(s) agrees to pay for said service as bills are due in accordance with the bylaws and policies as provided by the board of directors of the cooperative and further agrees to comply with rates, rules, and regulations approved by the Arkansas Public Service Commission as they now exist or as may hereafter be adopted and in effect at the the time of delivery. The applicant(s) further agrees to release and discharge said cooperative from any liability for damages suffered by reason of interruption, discontinuance or disconnection of service hereunder from any cause, or by reason of the maintenance, location or existance of any of the facilities, fixtures or systems located on or adjoining the property supplied, and by which such services are furnished or delivered.

Applicant further agrees that $7.00 of his her yearly electric bill will be allocated for a subscription to Rural Arkansas.

Please Note: You must provide a copy of your photo ID via email, mail or in person.