Membership Application for Electric Service

Please complete the below application to apply for new service.  Application for service may also be made in person at the Shelbyville office or by calling us at 1-800-292-6585. There is no membership fee. A deposit is required but may be waived upon a consumer's showing of satisfactory credit or payment history.  When applying for service, you will be given additional information that describes benefits and opportunities of the cooperative.  If you have any questions regarding new service, please contact our office during normal business hours. Please allow up to three business days for service request to be completed. Service Requests made on a holiday may not be available to process, therefore, we ask that you please contact the office.

Please click here to view more information on our Prepay service and indicate in the field area provided below if you are interested in this service.

Note: All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant's First Name:   *
Applicant's Last Name:   *
Applicant's Middle Initial:  
Applicant's SS#:-  -   *
License State:  
Birth Date:    
Employer:  
Date of Birth:  *
Applicant's Place of Employment:  
Would you like this to be a Prepay account?  *

Mailing Address:
Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please enter the address where service is required:
Service Address:   *
City, State:   *
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -   
Work Phone:-  -     
Spouse's Name: 
Spouse's SS#:-  -   
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  
Date of Birth:  
Spouse's Place of Employment:  
Work Phone:  
Cell Phone:  

Online Portal:
As one of our services, we provide an online portal for viewing/paying bills and to manage your account. If you'd like to use this service, you can specify an Internet Password and Password Hint at this time. For security purposes, please specify an Internet Password that has a combination of alpha and numeric characters.
Online Portal Password:  
Confirm Internet Password:  
Password Hint:

Existing or Previous Service:
Have you ever had service with Shelby Energy?
    
Account Number:
Fees & Deposit Information:
There is no membership fee. A deposit is required but may be waived upon a consumer's showing of satisfactory credit or payment history.  When your account is created in our system, you will receive an email with the total amount due on your new account, including deposit amount (if applicable).


Does this service require additional meters?
(i.e. barn, building, house, garage)		  *
Do you own or rent at the service location?   *
Please select your preferred billing method:   *
 
The undersigned (hereinafter the "Applicant") hereby agrees for membership in, and agrees to purchase all electric energy used on the premises specified in this Application from, Shelby Energy Cooperative, Inc. (hereinafter the "Cooperative") upon the following terms and conditions.  The Applicant will comply with and be bound by the Articles of Incorporation and By-Laws of the Corporation and any Rules & Regulations adopted by the Board of Directors.

By signature heron, Applicant acknowledges that Applicant has read the foregoing, received a copy thereof, agrees to be bound by same, and acknowledges that this is the entire agreement between the parties and that there are no oral agreements between the parties.

A membership application must be agreed to, signed and submitted to Shelby Energy within 15 days of service being activated to avoid interruption of service.  Click here for your membership application.


You will receive an e-mail shortly, confirming your request for service. This request for service will not be processed until you confirm the request by selecting the link provided in the confirmation e-mail. Please note, based on individual security settings, this email may appear in your junk email folder.

**Prepay Service Applicants** The undersigned (hereinafter called the “member”) hereby applies for participation in the voluntary Prepay service offered to members of Shelby Energy Cooperative, Inc. (hereinafter called the “Cooperative”), and agrees to the following terms and conditions.
I understand typing my name in the field area provided below is my electronic signature.
  Applicant:     *