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To apply for electric service with North Georgia EMC, please complete and submit the following application. Submission of this form provides permission for NGEMC to review and verify identity as required by the *FTC under the FACT Act.

Please call our office for same day or next day service. Dalton, Fort Oglethorpe, and Calhoun offices: phone hours are 7:30 pm to 5:30 pm Monday through Friday and drive thru is open from 7:30 am – 5:00 pm. Trion Office: is 8:00 AM to 5:00 PM Monday through Friday. Our lobbies are not open at this time.

Dalton (706) 259-9441, Ft. Oglethorpe (706) 866-2231, Calhoun (706) 629-3160, Trion (706) 734-7341

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

Today's Date:
Date Service is Desired:	*
Type of Request:	*

Primary Account Holder Information: First Name:	*
Last Name:	*
Middle Initial:	*
Social Security Number:	- - *
Valid Driver's License Number:	*
Issuing State of Driver's License: *A valid driver’s license or state ID card will be required for identity purposes prior to connection of service.	*
Date of Birth:	*
Employer:

Mailing Address:

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

Address of Service Location:

Check here if same as Mailing Address

Service Address:

Service Type (Construction Required or Existing Service):

City, State, Zip Code and County of Service Location:
*Please supply directions if new location with no box number

E-mail:	*
Confirm E-mail:	*

Home Phone:	- -
Cell Phone:	- - *
Employer Phone:	- -
Co Applicant Information: Name: (if applicable)
Social Security Number:	- -
Valid Driver's License Number:
Issuing State of Driver's License:
Date of Birth:
Employer:

Employer Phone:
Cell Phone:
Home Phone:
Email Address:

Online Access:
Set up your on-line password now for easy access to your account at www.ngemc.com or phone app “myngemc account”.

Internet Password:
Confirm Internet Password:
Password Hint:

Existing Service:
Have you ever had service with North Georgia EMC?

YesNo

Account Number:

Membership Fee:
Service Connection Fee:

Would you like this to be a Prepay Account?
Is there a second meter at the location that needs to be connected? (yes or no)	*
If yes, please provide any additional information.
Is there an existing outdoor light at the location you would like to keep? *Additional monthly fees will be associated with this option. (yes or no)	*
Are you interested in signing up for EMC Security? (yes or no)	*
Are you interested in heat pump loans?
Do you own or rent this location? *Proof of rental will be required prior to connection of service.	*
ORU Thanks to the generosity of NGEMC members like you, Operation Round Up has given more than $2.5 million dollars to schools, non profit agencies, and emergency relief efforts in the NW Georgia community. Please consider rounding up your bill to the next dollar amount. 100% of the funds go directly to your community. Would you like to participate in ORU?	*
Go paperless. Please select your preferred billing method:	*

Terms and Conditions Printable Version

1. If this application is accepted by the Cooperative, the Applicant will pay to the Cooperative a Membership fee in the amount of $10.00, a Consumer Deposit and an Other Deposit if applicable and a Connect Fee in the amount of $15.00. Additional deposits may be required in accordance with the policies of the Cooperative now in force or hereafter adopted.
2. The Applicant will, when electric energy becomes available, purchase from the Cooperative electric energy used on the premises described in the application and will pay therefore monthly at rates which will be fixed by the Board of Directors of the Cooperative.
3. The Applicant will cause the Applicant's premises to be wired to furnish a point of attachment for Cooperative's service facilities which will meet the National Electrical code and any applicable state or local electrical codes. The Cooperative will designate the location of this point where its attachments and meters will be located.
4. The Applicant will comply with and be bound by the provisions of the Cooperative's articles of incorporation and by-laws, including the membership obligations defined therein; and such rules and regulations as adopted by the Cooperative.
5. The Applicant, by paying a membership fee and becoming a member, assumes no personal liability or responsibility for any debts or liabilities of the Cooperative.
6. If Applicant fails to make any payment when due, the full unpaid balance of the Applicant's account may, at the option of Cooperative, become due and payable and subject to immediate termination of electric service. If the Applicant's account is referred for collection by the Cooperative to any outside agency and/or attorney who is not a salaried employee of the Cooperative, the Applicant will, to the extent permitted by law, pay all fees, including 30% collections fee and/or court costs, including 15% attorney's fees. If Applicant has more than one service connection from the Cooperative, any payment for service furnished to Applicant by the Cooperative may, at the Cooperative's option, be allocated and credited on a pro rata basis to any unpaid balance for all such service connections.
7. Easements: The undersigned hereby grants to the cooperative the necessary rights, privileges and easements, a minimum of 20 feet on either side of Cooperative's electric lines to construct, operate, replace, repair, maintain in perpetuity on, over and under the property owned or occupied by the undersigned, and in or upon all roads, streets or highways abutting said property, its lines or lines from the transmission or distribution of electric energy, and other telephone and telecommunication utilities, and will execute and deliver to the Cooperative any conveyance, grant or instrument which the Cooperative shall deem necessary or convenient for said purposes or any of them. The Cooperative may permit third parties to use the easement for the purpose of making attachments to the Cooperative's poles. All service lines supplying the undersigned with electric energy shall at all times be the sole property of the Cooperative, and the Cooperative shall have the right to access said property and utilize said easement to read its meter, repair and service, and upon the discontinuance of service for any reason, to remove the same.
8. The Cooperative will not be liable for, and the undersigned agrees to hold the Cooperative harmless, for any damage, whether direct or indirect, to electrical appliances, tools, electronic devices, computers, motors or similar items, or the premises in which they are located, caused by electrical surges, spikes, voltage irregularities, or other electrical phenomena which may travel through the electric distribution system of the Cooperative and which are caused by acts of nature; force majeure; or resulting from the wear and tear of the Cooperative equipment due to age, use or deterioration. The acceptance of this application by the Cooperative shall constitute a binding contract between the Applicant and the Cooperative, and in further consideration of said acceptance and the installation of facilities by the Cooperative, to provide the Applicant with electric energy, the Applicant agrees to take said energy from the Cooperative, so long as the Applicant occupies the premises served by the Cooperative. Applicant acknowledges receipt of a copy of this application. 
9.  The undersigned agrees to participate in Operation Round Up (hereinafter called ORU).  All contributions go to the North Georgia Electric Membership Foundation, a 501c(3) charitable organization. 100% of all funds received by the Foundation are given to non-profit agencies.  Participation shall begin the first billing period unless revoked by member under separate cover.

Check here that you have read and agree to the terms and conditions noted above.
By submitting this request, I, the above-named individual (hereinafter called applicant) hereby apply for membership in and agree to purchase electric energy from North Georgia Electric Membership Corporation (hereinafter called Cooperative).

The applicant agrees to abide by all Bylaws and Service Rules and Regulations of the Cooperative. A one time Membeship fee applies.

*Refers to the Federal Trade Commission Administration Fee

Check here to acknowledge this business transaction is pursuant to the Uniform Electronic Transactions Act, O.C.G.A. 10-12-1, et.seq, which provides that an electronic signature is valid.

Electronic Signature (Applicant Name): *

Service Address:
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