Please complete the below application to request electric service from Holston Electric Cooperative. Service Requests are processed from 8 a.m. to 2 p.m. Monday through Friday. We need a minimum of 24 hours notice before service can be established online. If you have any questions, or need service immediately, please contact our office 423-272-8821. 

If you are renting or leasing your property, a rental agreement is required and service will not be processed until the documentation is received. If property is owned, proof of ownership or deed is required and service will not be processed until the documentation is received. Please email documentation to onlinerequests@holstonelectric.com.  Two forms of government issued identification are required prior to processing. 

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

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant #1:
Legal First Name:		   *
Legal Last Name:   *
Legal Middle Initial:  
Social Security #:--  *
Driver's License #:  *
License State:  
Birth Date:    
Employer:  
Current Street Address:  *
City, State & Zip:  *

New 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 new service is required:
*(Do not include city, state or zip code information)
Service Address:  
Service Type (Construction Required or Existing Service):  
Comments and/or Directions to New Construction:  
E-mail:  *
Confirm E-mail:  *
New Home Phone:--   *
Cell Phone:--  
Employer Phone:--   
Applicant #2:
Co Applicant Name:		 
Co Applicant Social Security #:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  

Online Access:
If you would like access to your account online, please create a password below.  You can pay your bill, view your bills and manage your account with online access. For security purposes, please specify a password that has a combination of numeric and alpha characters.
Password:  *
Confirm Internet Password:  
Password Hint:

Existing Service:
Have you ever had service with us before?
    
Account Number:
Fee and Deposit Information:
The below shown $25 connection fee must be paid prior to connection. To determine if a security deposit is required, we will run a credit check using your social security number or federal tax ID number. If you do not wish to have your credit checked, a maximum deposit will be required before your application is processed. If a deposit is required, it will need to be paid before service is established. Membership fees, together with any service security deposits, service connection deposit or fee, facilities extension deposit, or contribution in aid of construction shall be charged as applicable. Once your account is created in our system, you will receive an email with the total amount due on your new account, including deposit amount (if applicable). Applications remain pending until fees are satisfied with payment and identifying documentation is submitted.

Connection Fee:  

Are you interested in bank draft?  *
 *
Landlord Name:
*enter n/a if not applicable		  *
Landlord's Phone:  
Service Property is:   *
GO GREEN! Preferred Billing Method:   *
 
The undersigned (hereinafter called the "Applicant") hereby applies for membership in and agrees to purchase electric energy from Holston Electric Cooperative, Inc. (hereinafter called the "Cooperative") upon the terms and conditions and bylaws.  I understand that in the event both applicants no longer reside in the household, any membership, deposit, and/or credits on an account will be issued to applicant #1 listed.

DISCLAIMER: COOPERATIVE AGREES TO PROVIDE ELECTRICAL UTILITY SERVICE TO SIGNED CUSTOMER. UPON SIGNING, APPLICANT AND CO-APPLICANT CONFIRM ALL INFORMATION PROVIDED HEREIN IS TRUTHFUL AND ACCURATE, AND ALSO AGREE TO COMPLY WITH COOPERATIVE'S SERVICE RULES AND REGULATIONS, AND TO PROMPTLY PAY FOR SERVICES RECEIVED. UPON ACCEPTANCE BY CHECKING THE BOX BELOW, THIS FORM WILL SERVE AS A CERTIFICATE OF MEMBERSHIP AND WILL BE FILED ELECTRONICALLY AT COOPERATIVE.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *