Online Web Form

Application for Service

Please complete this application to apply for new service with Tallahatchie Valley EPA. All new applicants are required to pay a $20.00 Member Fee and $30.00 Connect Fee before service is connected. If applicable, a credit check may also be necessary to determine if a security deposit is required.

If you have any questions regarding setting up service, please feel free to contact our office at (662) 563-4742.

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

Today's Date:	Today's Date: Invalid Date Format.
Date Service is Desired:	* Invalid date format.
Type of Request:	*

Applicant Information: First Name:	*
Last Name:	*
Middle Initial:
SSN:	-- *
License State:
Birth Date:	Invalid date format.
Employer:

Date of Birth:	*
Employer:
Employer Address:
City, State:
Zip Code:

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

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

Service Address:
Please enter the street address where service is required:

Check here if same as Mailing Address

Service Address:

Service Type (Construction Required or Existing Service):

Directions to Service Address:

E-mail:	*Invalid E-mail format.
Confirm E-mail:	*Invalid E-mail format.

Home Phone:	-- *
Cell Phone:	--
Work Phone:	--
Co Applicant Information: Name:
SSN:	--
Co Applicant Driver's License:
Co Applicant License State:
Co Applicant Birth Date:	Invalid date format.
Co Applicant Employer:

Date of Birth:
Employer:
Employer Address:
City, State:
Zip Code:

Online Access:
As one of our services, we offer an online application for viewing and paying bills. If you would 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 ;east 4 characters in length and is case sensitive.

Internet Password:
Confirm Internet Password:
Password Hint:

Existing Service:
Have you ever had service with us before? YesNo

Account Number:

Note:
Depending upon the results of your credit check, you may be required to pay a deposit in full, prior to electric service being connected.

Membership Fee:
Connect Fee:

Billing Method:
Note: If EBill is selected, you will not receive a paper bill.

Terms and Conditions Printable Version

1. The Applicant agrees to pay the sum of $20.00 for membership subscribed for by Applicant.
2. When electric service is made available, Applicant agrees to pay a service charge of $30.00 and to purchase from the Association, and pay monthly for all electric energy used, as measured by Association’s meter, on applicable rate schedule.  Applicant agrees to pay minimum monthly bill per month whether or not the corresponding kilowatt hours is consumed.
3. The Applicant agrees to permit authorized agents of the Association free access to the premises of consumer for the purpose of inspecting, meter reading, repairing, or removing property of the Association.
4. Applicant will cause his premises to be wired in accordance with the provisions of the latest edition of the National Electrical Code.
5. Applicant will comply with and be bound by provisions of the bylaws and rules and regulations of the Association, as may be adopted from time to time.  Copies of the bylaws and rules and regulations are available for inspection at the office of the Association.

Checking this box is acceptance of this agreement between the above specified Applicant and Tallahatchie Valley Electric Power Association and shall constitute as an agreement for electric service. Furthermore, the applicant has read and agrees to the above terms and conditions.
By submitting this application request, I also agree that a credit check may be submitted to determine if a security deposit is required.

Service Address:
Latitude:
Longitude: