APPLICATION FOR MEMBERSHIP AND SERVICE

Thank you for the opportunity to serve you by applying for membership and utility service, the process begins with this form. Information from the form will be used to perform a credit check and determine your deposit amount. The deposit amount could be $0, $200, or $400, in accordance with our policy 301. Next, a membership account will be created in our billing system, with your deposit amount, $10 membership fee, and $40 service charge applied to the account as balance due. You will receive an automated email that will reflect the total balance due. Service will be established once the deposit, membership fee, and service charge is paid. 

While we strive to be quick and efficient, we do not guarantee this process will complete the day you submit the application.

Applicants with concerns regarding their deposit amount or those that would like to be aware of their daily usage and bill, we encourage looking at our daily billing option called Prepay program.

If you have questions that have not answered on NEMEPA.org, feel free to call us at 662-234-6331 or toll free 877-234-6331 to speak with a customer service representative. 

Did you know that we also offer fast, reliable fiber internet service through NE SPARC? Visit us at NESPARC.com to see how NE SPARC can improve your life.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
Applicant First Name:		   *
Applicant Last Name:   *
Social Security Number:--  *
Driver's License #:  *
License State:   *
Birth Date:  *  
Service Information:
Please indicate if service is being requested for a House, Apartment, Mobile Home or Other:		  *
If Other, please specify:  
Please indicate what city the service location is in:  *

Mailing Address:
Please mail bills to the address shown below:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Address To Connect:
Please provide the address where service is being requested including Apt# and Building#, if applicable:
Service Address:   *
Comments:  
E-mail:  *
Confirm E-mail:  *
Note: Enter Cell in both Home & Cell Phone fields, if applicable.
Home Phone:		--   *
Cell Phone:--   *
Work Phone:--   
Spouse Information:
Name:		 
Social Security Number:-- 
Driver's License #:  
License State:  
Birth Date:    
Cell Phone:  

Membership Fee:  
Connection Charge:  

Will this be a standard (monthly) billing or prepay (daily) billing account?  *
Do you rent or own the service location?   *
Please select your preferred Billing Method:   *
 
I (hereinafter called the "Applicant") have read and agree to the terms and conditions and Prepay Payment Program Agreement (if applicable) and hereby apply for membership and agree to purchase electric energy from North East Mississippi Electric Power Association (hereinafter called "North East").
I understand that checking this box and typing my name in the field provided below is my electronic signature. By signing below, you give North East consent to contact you via phone, send emails and SMS text alerts to inform you of account activity including account balance and usage information. If your contact information changes, it is important that you contact North East to request the information be updated. Account alert and notification preferences can be managed online or via our mobile app.
  Applicant Name:     *