Please complete this form if you are moving into a location with existing electric service. If you are establishing service at a new location, a location that does not currently have electric power in place, such as a new construction, please click here for more information on requirements. Same day service is offered until 4:30 pm. 

Important Note: A copy of your driver's license is required for service to be connected.  Proof of ownership or a copy of the rent receipt is also required. You can email a copy to forms@irwinemc.com. 

If you need assistance, our friendly customer service representatives are ready to help you get your electricity turned on. Call us at (229) 468-7415 or toll-free at (800) 237-3745 Monday through Friday, 8:00 a.m. through 4:30 p.m. for assistance. 

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


Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Member Information:
First Name:		   *
Last Name:   *
SSN:--  *
Driver's License #:  *
License State:  
Birth Date:    

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

Service Address:
Physical 911 Address of Location
Service Address:  
Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Spouse Information:
Name:		 
SSN:-- 
Driver's License #:  
License State:  
Birth Date:    
Nearest Relative Not Living With You Information:
Name:		  
Street Address:  
City, State:  
Zip Code:  
Phone Number:  

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 and password hint now for easy access to your account at https://irwinemc.com/.  Please note passwords must be a combination of letters and numbers.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Member:
Have you ever had service with Irwin EMC?

    
Account Number:
Fee and Deposit Information:
New applicants are required to pay Security Deposit(s) and Fees. We need permission to check your credit history. Security deposits vary depending on your credit history. Rent receipt and copy of current picture identification is needed.

Interested in waiving your deposit?  Click here for more information on Advance Pay!

Membership Fee:  
Misc Chg Amt:  

Would you like this to be a Advance Pay Account? (yes or no)  *
If yes, please indicate if you want alerts by phone call, email or text.
*if phone call, indicate home or cell		  
If yes, please indicate preferred alerts types:
(Payment Confirmation, Service Disconnected, Low Balance and/or Balance and usage alert)*Low Balance Amount will be set to $20.00. You may change this by logging into your account online. 		 
Is there an existing outdoor light at the location? (yes or no)  *
If yes, do you want to keep the Outdoor Light? (yes or no)
Note: There are monthly charges associated with this request.		  
Do you own or rent the service location?   *
Participate in Operation Round Up?  
Please select your preferred billing method:   *
 
I have read and agree to the Service Rules & Regulations , ByLaws, and Advance Pay Terms of Service (if applicable) of Irwin EMC. By submitting this application request, I also agree that a credit check may be submitted to determine if a security deposit is required. Permission is hereby granted to Irwin EMC to check my credit history for the sole purpose of determining my total deposit amount. I fully understand that I must provide all of the following: Photo ID, Social Security Number, Rent/Lease Agreement or Proof of Home Ownership. If these items are not provided or the Social Security Number does not match, the maximum deposit may be applied. I also give Irwin EMC express consent to send SMS text alerts, Emails and Phone Calls to inform you of account activity. If your mobile number changes, it is important that you contact Irwin EMC to update the information. For Advance Pay Accounts, I agree that my unpaid balance of will be collected at a rate of 50% of each payment I make until the above amount has been paid in full. I understand that the deposit on this account will be applied toward my previous amount due. I also understand that if my Advance Pay account is negative, I will be subject to disconnection. In order to have my electricity reconnected, I will need to pay any amount due plus $20. There will be no arrangements made with Advance Pay members. Advance Pay accounts will not be required for a credit check.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *