Application for Service

Please complete the below application to request service be connected.  Note, service cannot be connected on weekends or holidays.  If you would like same day service, please notify our offices. If you have any questions regarding new service, please contact your local office during normal business hours.  All fields with the asterisk (*) are required.


Billing Options: Standard Billing $275.00 or Prepay Electric $120.00 


Ask about our Plus One Program 

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Your First Name:   *
Your Last Name:   *
Social Security Number:--  *
Birth Date:    
Employer:
(please indicate if unemployed or retired)		   *
Nationality  

Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Please enter the street address where service is required:
Service Address:   *
Service Address City/Comments:   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--  
Work Phone:--   
If you are married we will need the following:
Spouse Name:		 
Spouse Social Security #:-- 
Spouse Employer:  
Are you married, single, divorced or widowed?  *
Spouse Cell Phone:  
Spouse Work Phone:  

As one of our services, we provide an online portal for viewing/paying bills and account management. If you would like to use this service, please specify a Password and Password Hint below. For security purposes, please select a password with a combination of both letters and numbers.
Password:  *
Confirm Internet Password:  
Password Hint:

Have you ever had service with us before?
*Please enter numbers before the dash only in the account number field    
Account Number:
Pennyrile Electric is a cooperative, providing electric service to its members.  Anyone desiring service is required to become a member of the cooperative.  Before service can be given, the following charges must be paid.

Membership Fee - $15.00
This fee may be applied to your final bill when service is no longer desired.  If you relocate within the Pennyrile service area, this fee is transferable.  (One membership will cover multiple accounts.)

Connection Fee - $35.00
This fee is not transferable or refundable.

Residential Deposits:
Residential Regular Deposit - $225.00

Residential Prepay Reserve Fee - $50.00

Non-Dwelling Deposit - $50.00

A new or previous member authorizing a credit check and obtaining a good credit rating will not be required to pay a deposit.  Present members with a good payment record will not be required to pay a deposit for a second meter.  If you have been cutoff at the same location in the last 24 months a deposit = twice the average bill is required.
  
A members deposit is automatically credited back to their account with 24 months of good payment records.  No delinquents, returns, or cutoffs.  

Membership Fee:  
Deposit:  
Other Deposit:  
Connect Fee:  

For the next 4 fields, please indicate one of the following:
Military or Non Military:		  *
Electric Heat/Propane Gas/Natural Gas/Wood Heat/Kerosene/Geo Thermal/Oil:  *
Electric Air or No Air:  *
House/Mobile Home/Apartment/Duplex/Shop/Barn/Grain Bin:  *
Status at Service Location:   *
Please select your preferred billing method:   *
 
By checking here, I (we) would like to become a member(s) of Pennyrile Electric Cooperative.  And I (we) understand that before service can be given, the described and respective charges for Residential service, including Prepay, must be paid. I (we) understand that if the service location has been vacant for a year or more that an electrical inspection is required before service can be connected.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *