APPLICATION FOR SERVICE AND MEMBERSHIP

Please complete the below form to apply for service with North East Mississippi EPA. Please note, we do not guarantee same day service request. All fees and deposit must be paid prior to service being connected.

Once your account has been created in our system, you will receive an email including the total amount that must be paid before service is connected. The deposit amount is based on a credit check and will be $80, $200 or $400. The amount will also include a $10 Membership and $30 Service Charge. Total owed will be $120, $240 or $440.

A Prepay account can be created for $140.00 ($50 Deposit, $10 Membership, $30 Service Charge and $50 Prepay Credit). To request a Prepay account, please indicate "yes" in the "Will this be a Prepay Account?" field below.

If you have any questions regarding starting new service, please call 662-234-6331 or toll free 1-877-234-6331 and a customer service representative will assist you.

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


Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
Applicant First Name:
  *
Applicant Last Name:   *
Middle Initial:  
Social Security Number:-  -   *
Driver's License #:  *
Date of Birth:  *
Employer:  
Will this be a Prepay Account?  *
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:-  -     
Co Applicant Information:
Co Applicant Name:
 
Co Applicant SSN:-  -   
Co Applicant Date of Birth:  
Co Applicant Cell Phone:  
Co Applicant Employer:  

Online Access:
As one of our services, we offer an online application for viewing and paying bills. Please specify a Internet Password and Password Hint for this service below. For security purposes, please specify an Password that is at least 4 characters in length.

Internet Password:  *
Confirm Internet Password:  
Password Hint:

Existing or Previous Service:
Have you ever had service with NEMEPA?
    
Account Number:

Fee and Deposit Information:
All new accounts are required to pay a membership fee and a connection charge. Based on the results of a credit check, a deposit may also be required. When your account is created in our system, you will receive an email including the total amount due on your new account, if applicable.


Membership Fee:  
Connection Charge:  

Student/Temp Resident Permanent Address:
Street Address/P.O. Box:
 
City, State:  
Zip:  
Other:
Cell Phone Provider (required for Prepay) please enter N/A if not Prepay:
 *
If you rent, specify Landlord/Apartment Complex:
Please note, if renting, a lease agreement may be required.
 
Do you want yard lights left on?  
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").