Electric Service Application
Please complete the below application to apply for service with LaGrange County REMC. NOTE: All fields with RED (*) are required. After hitting submit, you should get a confirmation email. If you do not, then the application has not been submitted.

If you have any questions regarding new service, please feel free to contact customer service during normal business hours at (877) 463-7165 or send an email to customerservice@lagrangeremc.com.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant:
First Name:		   *
Last Name:   *
Middle Initial:  
Social Security Number:--  *
Date of Birth:
Example format (xx/xx/xxxx)		  *  

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

Service Address:
Please enter the street address where service is required:
Service Address:   *
Service Type (Construction Required or Existing Service):   *
Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:
*if home and cell are the same, please enter in both field areas to ensure accurate correspondence		--   *
Cell Phone:--  
Other Phone:--   
Spouse:
Name:		 
Social Security Number:-- 
Birth Date:    
Secondary Email:  
Confirm Secondary Email:  
Other Phone:  
Electronic Signature: I understand that typing my name in the field provided is my electronic signature. *Required if Spouse  

Online Access:
We offer a portal and mobile app for ebill, online bill payment and account management. If you would like to access your account online, please create a password and password hint below. For security purposes, a minimum password length of 10 characters and a combination of uppercase letters, lowercase letters, numbers, and symbols (!@#$%^&*) is required.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Deposit Policy:
All new accounts and previously disconnected accounts being reconnected are subject to our deposit policy. All deposit decisions will be based upon the creditworthiness of each applicant. The REMC will use an accredited third party organization to apply nondiscriminatory methods to establish each applicants deposit decision. The third party organization is licensed, accredited, and bound by all State and Federal laws using consumer guidelines established by the Federal Trade Commission. REMC is required to provide an “Adverse Letter” to each applicant required to pay a deposit as a condition of service. When your account is created in our system, you will receive an email including the total deposit due on your new account, if applicable.

Wish to waive your deposit? Click here for more information on Prepay billing!


Would you like this to be a Prepay Account?
(indicate yes or no)		  *
Do you rent or own the service location?   *
Please select your preferred Billing Method:
Please Note: You will receive all bills via email, unless you request otherwise.		  
 
The applicant(s) hereby agree to the following terms as an express condition to membership:

  • Comply with all applicable law and legally binding agreements regarding the LaGrange County Rural electric Cooperative (the “Cooperative”), including, but not limited to, the Cooperative's Articles of Incorporation (the "Articles"), these Bylaws, the Cooperative's service rules and regulations, the Cooperative's rate or price schedule, and any policy, resolution, action, regulation, or amendment adopted by the Board (collectively the "Governing Documents");

  • At prices, rates, or amounts determined by the Board of Directors of the Cooperative, and in a manner specified by the Cooperative, pay the Cooperative: (i) for all Cooperative Services used, received, or purchased by the Member themselves or at, or for, any dwelling or structure owned, controlled, or directly occupied by the member; (ii) dues, assessments, fees, deposits, contributions, or other amounts required by these Bylaws or the Board; and (iii) dues, assessments, fees, deposits, contributions, or other amounts required by law; and

  • Complete any additional or supplemental document or contract required by the Board for the Cooperative Services which the Applicant is seeking to use, receive, or purchase.

  • "Cooperative Services” shall mean: as required or allowed by law, using, receiving, or purchasing electric power from or through the Cooperative.

(A copy of our Governing Documents are available on the web, at www.lagrangeremc.com, or available from our office.)

By clicking "Submit" the persons named herein agree to the terms contained in the application and attest to having full authority to act on behalf of and to bind both parties accordingly.

MEMBERSHIP IN THE COOPERATIVE IS SUBJECT TO THE APPROVAL OF THE COOPERATIVE.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *