New Service Application/Membership Agreement
Please complete the below application to apply for service and membership with LaGrange County REMC. To apply for Joint Membership, select the "Joint" option from the Type of Request dropdown box below. Legally married individuals principally residing at the same location may apply for joint membership in the Cooperative (a "Joint Membership") by completing spouse field requirements below, jointly signing and executing a membership application, and by jointly completing the membership procedures.

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

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

Mailing Address:
Please enter the address where bills should be sent:
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):   *
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -   
Work Phone:-  -     
Example Format (Doe John A)
Social Security Number:-  -   
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  
Date of Birth:
Example format (xx/xx/xxxx)

Online Access:
As one of our services, we provide an online application for viewing and paying bills. If you'd like to use this service, you can specify an Internet Password and Password Hint at this time. For security purposes, please specify an Internet Password that is at least 4 characters in length.

Internet Password:  
Confirm Internet Password:  
Password Hint:

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

Account Number:

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.

Do you rent or own the service location?   *
Please select your preferred Billing Method:   *
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, 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.