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Residential Application (Translated Version)

Esta aplicación está disponible para traducción. Para traducir la Solicitud de Servicio Residencial para Nuevos Miembros, desplácese hasta la parte inferior de la página y busque el botón "Seleccionar idioma". Cuando se complete la solicitud, se enviará por correo electrónico a memberservice@chelco.com. Si tiene alguna pregunta, llame al (850)892-2111. Si necesita un traductor que le ayude a configurar el servicio, por favor traiga uno a una de nuestras oficinas. Las ubicaciones de las oficinas están disponibles en https://www.chelco.com/chelco-offices-hours.

Translation: This application is available for translation. To translate the New Member Residential Service Application, scroll to the bottom of the page and look for the "Select Language" button. When the application is complete, it will be emailed to memberservice@chelco.com. If you have any questions, please call (850)892-2111. If you need a translator to help you set up the service, please bring one to one of our offices. Office locations are available at https://www.chelco.com/chelco-offices-hours.

Residential Application

Type of Application

Type of Rate

Membership Rates

Connect Date

Permit Number

Primary Applicant

Applicant's Legal First Name

Applicant's Legal Last Name

Social Security #

Date of Birth

Date of Birth: Date

DL or ID#

State

Expiration Date

Primary Phone #

Secondary Phone #

Email Address

Emergency Contact Name (Someone not residing with you)

Emergency Contact Telephone

Would you like to add a joint applicant?

Yes

Joint Applicant

Joint Applicant's Legal Name

Social Security #

Date of Birth

DL or ID#

State

Expiration Date

Primary Phone #

Secondary Phone #

Service Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Driving Directions

Service Description

House

Mobile Home

Well

󠄀Recreational Vehicle (RV)

Other…

Enter other…

Is the mailing address the same as the service address?

Yes

I am the

Home Owner

Renter

Please upload the completed representation of owner/landlord or rental agency document. You may also email it to memberbilling@chelco.com.

Representation of Owner/Landlord or Rental Agency Document

One file only.
10 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

Name of Landlord/Rental Agency

Landlord Phone #

Mailing Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Important

Status message

Residential Tax Exemption: The State of Florida does not charge sales tax for residential household use. By signing this residential application, I declare that the use of electricity is exclusively for residential use. If my usage changes, I understand it is my responsibility to notify CHELCO.

Request for Credit Inquiry: As Choctawhatchee Electric Cooperative, Inc. (“CHELCO”) requires a credit check before waiving security deposits, the undersigned consents and authorizes CHELCO to obtain a consumer credit report on the undersigned for such purpose.

Operation Round Up: The Operation Round Up program serves our local communities by donating to charities and nonprofit organizations through member participation of rounding their bill up to the next dollar. Those extra cents each month (an average of $6 per year) funds Operation Round Up. You are automatically enrolled unless you opt out of the program. Our member service representative can provide you with additional information.

Special Needs Registry: CHELCO cannot guarantee uninterrupted service nor can we assign a priority status to individual residential accounts, including for members who have electric-powered medical devices. The State of Florida offers a voluntary Florida Special Needs Registry. This registry informs first responders of special medical needs if an evacuation is warranted. Please call the agency in your county:

Holmes: (850)547-1112
Okaloosa: (850)651-7150
Santa Rosa: (850)938-5360
Walton: (850)892-8065

I agree to the General Conditions & Terms of Agreement.

General Conditions & Terms of Agreement

GENERAL CONDITIONS AND TERMS OF AGREEMENT

Would you like to sign up for Paperless Billing?

Yes

Primary Applicant Signature

Sign above

Signature Date & Time

Signature Date & Time: Date

Signature Date & Time: Time

Joint Applicant Signature

Sign above

Joint Applicant Signature Date & Time

Joint Applicant Signature Date & Time: Date

Joint Applicant Signature Date & Time: Time

Prepay Alerts & Communications

Threshold Balance Notification

Free Email Notifications

Low Balance Telephone Messaging

Low Balance Text Messaging

Prepay Rates & Terms

Status message

Daily Customer Charge

Residential: $.95 per day

Energy Charge: 7.046¢ per kWh (reduced from 7.046¢ on standard account) + or – Wholesale Power Adjustment

(All normal taxes and regulatory fees apply. Rates are subject to change in conjunction with CHELCO’s Tariff)

After 10 days in a disconnected status, your Prepay Metering account will be considered closed.
If the service is disconnected, the daily fixed charges (Customer Charge, light charge, etc…) will continue to accumulate on the member’s account and will be deducted from the member’s next advance payment purchase of electric service.
Notices of account activity and disconnection may be delivered by email, IVR, or text message. The delivery method will be chosen by the member and it will be the responsibility of the member to keep delivery method(s) current.
The applicant changes from Standard billing to Prepay remain on program for 180 days; applicant changes back Standard billing deposit required for location will be paid in full.

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CHELCO earns this award based on data modeled by the ACSI^® in 2023 and 2024. Award criteria are determined by the ACSI based on customers rating their satisfaction with CHELCO in a survey independent of the syndicated ACSI Energy Utility Study. For more about the ACSI, visit www.theacsi.org/badges. ACSI and its logo are registered trademarks of the American Customer Satisfaction Index LLC.