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Headquarters
877-876-3511

Altenburg
877-824-5233

Ste. Gen Service
573-883-5213

Perryville Office
573-547-2512

Perryville Service
573-547-2511

Customer Service

Apply for Service

Connect to Existing Service

Steps to becoming a member of Citizens Electric.

  • Complete the online application
  • Accept our terms and conditions
  • Print the completed application
  • Sign the application
  • Mail or fax the application to your local office.
  • Click on submit
Information:

* Required Field

*Applicant First Name:  
*Applicant Last Name:  
*Social Security Number:  
*Date of Birth:  
Co-Applicant First Name:
Co-Applicant Last Name:
Co-Applicant Social Security Number:
*Applicant Daytime Phone:  
Email: 
Home Phone:
Cell Phone:
New Service Address
*Address 1:  
Address 2:
*City:  
*State:  
*Zip:  
Previous Service Address
*Address 1:  
Address 2:
*City:  
*State:  
*Zip:  
Property Owner Information
Do you own the property where service is requesed?
If no, provice Name and Address of Property Owner.
Property Owner's Name:
Address 1:
Address 2:
City:
State:
Zip:
Is there a dusk to dawn light on the property?
Is there a Citizens Electric rental light?
Employment Information
Employed Full Time?
Number of Years Employed:
Employer:
*Address 1:  
Address 2:
*City:  
*State:  
*Zip:  
Previous Mailing Address
[Where you currently receive mail]
Check this box to indicate that your previous Mailing Address is the same as your previous Service Address.[leave address fields blank]
*Address 1:  
Address 2:
*City:  
*State:  
*Zip:  
New Mailing Address
[Where you will be receiving mail]
Check this box to indicate that your new Mailing Address is the same as your new Service Address.[leave address fields blank]
*Address 1:  
Address 2:
*City:  
*State:  
*Zip:  
Other Information
Person to contact in case of emergency:
*Requested by:  
*Service Start Date Requested
[You will be contacted for further information]  
Billing address:
[If same as your new address above leave blank]
Address 1:
Address 2:
City:
State:
Zip:
Additional Comments:


Signature of applicant:

__________________________________________

Please review the following Terms and Conditions.

By submitting and signing these forms you agree to the terms and conditions as they are stated.

A representative from Citizens Electric Corporation will contact you regarding this request. If we have not acknowledged your request within three working days, please contact our customer service representative at 1-877-876-3511.


 
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