APPLICATION FOR MEMBERSHIP
AND ELECTRIC SERVICE
Brandenburg, Kentucky

Please complete this application to apply for new service. You will be asked to pay a deposit (if applicable after credit check), and a $30.00 connect fee. The amount of the deposit is determined by the type of service you request, residential or non-residential. If you rent at the service location, please provide a copy of your lease agreement and a copy of your driver's license. If you own the service location, please provide a copy of your driver's license. Documentation can be sent via email or text to onlineforms@mcrecc.com or faxed to 270.422.4705.

If you have any questions about applying for service or charges for these services, call your Meade County RECC office. Brandenburg Office: 270.422.2162 and Hardinsburg Office: 270.756.5172.

All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
First Name:   *
Last Name:   *
Middle Initial:  
Social Security Number:--  *
Drivers License Number:  *
Drivers License State:   *
Date of Birth:  *  
Employer:  
Is this a primary residence?  *

IMPORTANT NOTE:
If you answered "yes" to primary residence,  a tax form is required.

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:  
Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--  
Cell Phone:--   *
Spouse Name: 
Spouse Social Security Number:-- 
Spouse Driver's License:  
Spouse Drivers License State:  
Spouse Date of Birth:    
Spouse Employer:  

Online Access:
We offer a variety of online services that our customers may use through our website. As one of our services, we provide an online system for viewing and paying bills. If you are interested in using this service, please specify an Internet Password and Password Hint at this time.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Fee & Deposit Information:
You will be asked to pay a deposit (if applicable), and a $30.00 connect fee. The amount of the deposit is determined by the credit check results or the type of service you request, residential or non-residential.

Residential: The amount of the deposit will vary according to the account.
Non-Residential: Determined by Usage

When your account is created, you will be contacted via e-mail or telephone with the total amount due on your new account, including the deposit amount (if applicable).

Connect Fee:  

Status at Location:   *
Please select preferred Billing Method:   *
 
I (hereinafter called the "Applicant") hereby apply for membership in and agree to purchase electric energy from Meade County RECC of Brandenburg, Kentucky (hereinafter called the "Corporation"). Furthermore, I have read and agree to the terms and conditions of the Corporation.