Electric and Propane Service Application | Polk-Burnett Electric Cooperative

Starting service for a(n)

Date to begin service in my name

Applicant

Applicant Type

Natural Person

Organization

Applicant name (first & last or business name)

Federal ID #

State of Incorporation

Email address

Primary phone #

Secondary phone #

Co-applicant

Co-applicant name (first & last)

Co-applicant email address

Primary phone #

Secondary phone #

Service location

Fire # and street name

City, State, ZIP Code

Own or rent

Type of service

Billing address (if different from above)

Mailing address

City, State, ZIP Code

Polk-Burnett Propane

Would you like Polk-Burnett Propane?

Yes

No

The billing for electric and propane are separate.

POLK-BURNETT ELECTRIC COOPERATIVE