Thank you for applying for electric service with Gibson Electric Membership Corporation. As a not-for-profit, member-owned and member-controlled cooperative, we look forward to serving you. We've created this online application form to make this process convenient. If you have any questions at all, please just call your local member service center and we'll be happy to help. Please Note: We cannot guarantee same day service or connect service after office hours, on weekends or on holidays. All fields marked with an asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Member Information:
First Name:		   *
Last Name:   *
Social Security #:--  *
Driver's License #:  *
License State:  
Birth Date:
(mm/dd/yyyy format)		    
Service Type:
(indicate Existing Service or Construction Needed)		  *

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

Service Address: (Physical 911 Address of Location)
Service Address:   *
City, State and Zip Code:
*And Additional Comments		   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Co Applicant Information:
Name:		 
Social Security #:-- 
Driver's License #:  
License State:  
Birth Date:
(mm/dd/yyyy format)		    
Co Applicant electronic signature:  

*A Co Applicant will have access to account information. A Co Applicant can also vote on behalf of the membership in trustee elections and for bylaw changes.

Member Portal Access:
We offer a portal for online bill payment and account management. If you would like access to your account online, please create a password using a combination of letters and numbers and create a password hint.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Member:
Have you ever had service with Gibson EMC?
*enter only digits that precede the dash (exp. 12345-001 should be entered as "12345")

    
Account Number:
To receive service, you will need to pay a $5 Membership Fee. This fee will be credited to your final bill. There also is a Connection Fee of $20 to $40 to cover the initial operational and administrative costs. It cannot be transferred or refunded. We will communicate the connection fee required for your service when we contact you for payment. 

PayGo or Monthly Billing: 
Gibson EMC offers two billing options: (1) Our most popular is PayGo, a pay before consumption option that allows you to avoid paying a deposit. You deposit money into your account and add money as you use electricity and your account balance decreases. You can set up text, email and telephone alerts to track your usage and account balance. Click here for more information on PayGo. (2) Monthly Billing is an after consumption option which requires a security deposit. The security deposit required will be the sum of the highest two consecutive monthly bills in the last twelve months for a service location. For residential locations without twelve months of billing history, the deposit will be estimated based on the square footage of the home. For commercial locations without twelve months of billing history, the deposit will be estimated based on the highest two consecutive months of a comparable location. Residential deposits may be refunded after three years provided there have been no disconnections for non-payment for 36 months. If a disconnection has occurred, the refund will be extended until the customer has established 36 consecutive months with no disconnections. Commercial account deposits will be refunded upon termination of service.

Once your account has been created, you will receive an email or phone call with the total amount that will need to be paid before service is connected. You may choose if you would like to pay a deposit or be on our PayGo program.


Which type of billing option do you prefer? (PayGo or Monthly)  *
If PayGo, who is your cell phone provider?  
Gibson Connect provides high speed fiber based internet service at competitive rates. Phone and TV service are also available. Would you like for us to contact you about Gibson Connect? (yes or no)  *
Outdoor Lighting If there is an outdoor light at your location, would you like to keep it? (yes or no)
*If there is no existing outdoor light but you desire for us to install one, please call our office.		  *
Do you own or rent the service location?   *
Opt in to Change for the Community Program?   *
If monthly bill, please select electronic bill or paper bill.   *
 
I agree to Gibson EMC’s Bylaws, Rules and Regulations, and Member Policies.  I have read Public Safety Policy Number 117. By submitting this application request, I consent to allow Gibson EMC to run a check to verify that my social security number and the name on my application match. I also give Gibson EMC express consent to send SMS text alerts, emails and phone calls to inform me of account activity such as billing and outages.  If my mobile phone number or email address changes, I agree to notify Gibson EMC of these changes or update my account profile information through www.gibsonemc.com.



PayGo Program:
I agree to the Terms and Conditions of the PayGo Program. Click here

We will send you a daily email notification showing your daily usage and balance and we will also send you a text message when your balance gets down to a 4-day average.
You can manage your notifications and alerts at www.gibsonemc.com.  To reach the portal, click on "Pay My Bill" at the top right side of the Home Page.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Member Name:     *