Thank you for applying for service with Monroe County EPA. If you have any questions regarding new service, please contact member services (662) 256-2962. Please Note: We cannot guarantee same day service or connect service after office hours, on weekends or on holidays. All fields marked with an asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
First Name:		   *
Last Name:   *
Middle Initial:  
Social Security Number:--  *
Driver's License or State ID Number:  *
License State:  
Birth Date:
(mm/dd/yyyy format)		  *  
Place of Employment:  
Relative/Reference:
Name:		  *
Phone Number:  *

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

Service Address: (Physical 911 Address of Location)
Service Address:  
Additional Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Work Phone:--   
Co Applicant Information:
Full Name:		 
Social Security Number:-- 
Driver's License or State ID Number:  
License State:  
Birth Date:
(mm/dd/yyyy format)		    
Place of Employment:  
Cell Phone:  
Work Phone:  
Relative/Reference:
Name:		  
Phone Number:  

Portal Site Access:
We offer a portal for online bill payment and account management. If you would like access to your account online, please create a password by using a combination of letters and numbers and also create a password hint.

Internet Password:  *
Confirm Internet Password:  
Password Hint:

Existing or Previous Service:
Have you ever had service with Monroe County EPA?
*enter only digits that precede the dash (exp. 12345-001 should be entered as "12345")

    
Account Number:

Fees for Electric Service Include:

Membership Fee – $50.00
Initial Meter Set Fee – $20.00 (Normal Business Hours)
Initial Meter Set Fee – $40.00 (After Hours)
Security Deposit – Based on credit risk


Once your account has been officially created in our system, you will receive a new account information email, including a total amount due on your new account, also including deposit amount (if applicable).

Connect Fee:  

Bank Draft: I WANT TO SIGN UP FOR AUTOPAY USING BANK DRAFT.
(Indicate Yes or No)		  *
Do you own or rent the service location?   *
Preferred Billing Method:
GO PAPERLESS, sign up for E Bill!		   *
 
By submitting this request, I (we) (hereinafter called the “Applicant”) hereby makes application for Electric Service and Membership at the above address and agrees to purchase energy from Monroe County Electric Power Association (hereinafter called the “Cooperative”) upon the following terms and conditions. I have read and understand the Bylaws, Rules and Regulations and Service Practice Rules.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *