Name(Required) First Last Phone(Required)Email(Required) New Service Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Social Security Number(Required) Spouse's Name** This is required if the secondary person is listed on proof of ownership or lease** Spouse's Social Security Number** This is required if the secondary person is listed on proof of ownership or lease** Name & Social Security Numbers of Occupants Over 18Driver License Number(Required) Business EIN Number Business Contact Name E-Billing(Required) Yes No Send Bill To:(Required) Rental Property?(Required) Yes No Owner of Property(Required) First Last Activation Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is this your Primary Residence?(Required) Yes No If not, describe. The undersigned hereby makes application for electrical service at the above address and agrees to pay for said service as measured by the System's meters, according to rates applicable to each billing. It is further agreed and understood that this document will apply for all future transfers of said service to this customer. In addition, the applicant agrees to abide by all rules and regulations as approved by TVA. The Applicant(s) also agrees to make a deposit, contingent on a soft credit check as security for any future electric bill they might owe, unless such a deposit is already being held by Dickson Electric System and no service is being provided. They further agree to be billed on the first bill the Connect Fee in the amount of $15.00 or $45.00 overtime fee, if applicable. They further understand that in the event their service is voluntarily terminated at their request, required notice is a least ONE business day, and that the deposit will be returned if the final billing has been paid in full. The Applicant(s) shall be responsible for all current consumed upon the premises from date of installation, and shall permit authorized agents of the System free access to the premises of the consumer for the purpose of inspecting, reading, examining, repairing or removing meter or other property, and maintaining right of way which includes vegetation management. The Applicant(s) further agrees that in the event they fail to pay a legitimate account, they will pay reasonable attorney's fees incurred by Dickson Electric System for collection of the delinquent account. The Applicant(s) understand and agree that Dickson Electric System may be limited in the amount of power that it can furnish due to limitation made by the wholesale power supplier. The Applicant(s) further understand and agree that the Dickson Electric System on some occasions may be unable to furnish electric power due to unforeseen and unavoidable circumstances. The undersigned herby certifies that they at the present time do not owe Dickson Electric System for prior service and further certifies that this application is their bonafide application and not submitted in conjunction with or on behalf of another person who has had electric service terminated by the System for failure to pay. They further certify that in the event this is a false application, they understand and agree that the electric service may be terminated immediately. Dickson Electric System does not discriminate on the basis of race, color, sex, age, handicap, religion, or nation origin. (Required) I hereby authorize Dickson Electric System to review my credit record and to make any necessary investigation of my credit transactions. In consideration of its undertaking to make such an investigation, I authorize any business or organization to give full information and records about me.(Required)Owner's Electronic Signature (Full Name)(Required) Picture of ID(Required)Max. file size: 300 MB.Proof of Ownership/Lease(Required) - Proof of Ownership (Closing Disclosure, Settlement Statement, Purchase and Sales Agreement or Property Deed) - Lease (First page and Signature page) Drop files here or Select files Max. file size: 300 MB. PhoneThis field is for validation purposes and should be left unchanged. Application For Electric Service Name(Required) First Last Phone(Required)Email(Required) New Service Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Social Security Number(Required) Spouse's Name** This is required if the secondary person is listed on proof of ownership or lease** Spouse's Social Security Number** This is required if the secondary person is listed on proof of ownership or lease** Name & Social Security Numbers of Occupants Over 18Driver License Number(Required) Business EIN Number Business Contact Name E-Billing(Required) Yes No Send Bill To:(Required) Rental Property?(Required) Yes No Owner of Property(Required) First Last Activation Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is this your Primary Residence?(Required) Yes No If not, describe. The undersigned hereby makes application for electrical service at the above address and agrees to pay for said service as measured by the System’s meters, according to rates applicable to each billing. It is further agreed and understood that this document will apply for all future transfers of said service to this customer. In addition, the applicant agrees to abide by all rules and regulations as approved by TVA. The Applicant(s) also agrees to make a deposit, contingent on a soft credit check as security for any future electric bill they might owe, unless such a deposit is already being held by Dickson Electric System and no service is being provided. They further agree to be billed on the first bill the Connect Fee in the amount of $15.00 or $45.00 overtime fee, if applicable. They further understand that in the event their service is voluntarily terminated at their request, required notice is a least ONE business day, and that the deposit will be returned if the final billing has been paid in full. The Applicant(s) shall be responsible for all current consumed upon the premises from date of installation, and shall permit authorized agents of the System free access to the premises of the consumer for the purpose of inspecting, reading, examining, repairing or removing meter or other property, and maintaining right of way which includes vegetation management. The Applicant(s) further agrees that in the event they fail to pay a legitimate account, they will pay reasonable attorney’s fees incurred by Dickson Electric System for collection of the delinquent account. The Applicant(s) understand and agree that Dickson Electric System may be limited in the amount of power that it can furnish due to limitation made by the wholesale power supplier. The Applicant(s) further understand and agree that the Dickson Electric System on some occasions may be unable to furnish electric power due to unforeseen and unavoidable circumstances. The undersigned herby certifies that they at the present time do not owe Dickson Electric System for prior service and further certifies that this application is their bonafide application and not submitted in conjunction with or on behalf of another person who has had electric service terminated by the System for failure to pay. They further certify that in the event this is a false application, they understand and agree that the electric service may be terminated immediately. Dickson Electric System does not discriminate on the basis of race, color, sex, age, handicap, religion, or nation origin. (Required) I hereby authorize Dickson Electric System to review my credit record and to make any necessary investigation of my credit transactions. In consideration of its undertaking to make such an investigation, I authorize any business or organization to give full information and records about me.(Required)Owner's Electronic Signature (Full Name)(Required) Picture of ID(Required)Max. file size: 300 MB.Proof of Ownership/Lease(Required) – Proof of Ownership (Closing Disclosure, Settlement Statement, Purchase and Sales Agreement or Property Deed) – Lease (First page and Signature page) Drop files here or Select files Max. file size: 300 MB. EmailThis field is for validation purposes and should be left unchanged.
