Apply for New Service

Please complete this application to apply for new service with Blue Grass Energy. Please indicate the type of service required by selecting one of the following options from the Type of Request dropdown box:

Residential: Service connected at an existing home or apartment;
Commercial: Service connected at an existing business;
New Construction: Service connected at a newly-constructed home or building

(*) Required Field

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant First Name:   *
Applicant Last Name:   *
Applicant Middle Initial:  
Applicant SSN:--  *
License State:  
Birth Date:    
Employer:  
Previous Address
Street:		  *
City, State:  *
Zip Code:  *

Mailing Address
Address where you prefer mail to be sent:

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

Service Address
Address where service is required:

Service Address:  
Service Type (Construction Required or Existing Service):   *
Additional Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--  
Work Phone:--   
Co Applicant Name
Please use format: Last First		 
Co Applicant SSN:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  
Please provide name of cell phone provider:  

Online Access 
As a convenience to our customers, Blue Grass Energy provides an online application for viewing and paying bills.  If you would like to use this service, in the section provided below, please specify an Internet Password and Password Hint for online account access.  For security purposes, please specify a password that is at least 4 characters in length.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Previous Service 
Have you ever had service with Blue Grass Energy?

    
Account Number:

Fee & Deposit Information 
A one time $25 Membership Fee is required to receive service from Blue Grass Energy. For Residential Applicants, a security deposit may also be required - based on a routine credit check - of $225. For Commercial Applicants, a security deposit may also be required - based on a routine credit check - of 1/6 annual bill. If you need temporary service, a charge of $35 applies. The construction of your service may require that you share in a portion of the cost associated with the construction. Once your account has been created, you will receive an an email including the total amount due.

Membership Fee:  

Outdoor Lighting
Is there an outdoor light at this location?		  *
If yes, would you like to continue the service (additional charges may apply)?  
Billing Method
Please select your preferred Billing Method:		   *
 
Checking this box confirms the applicant has read and agrees to the below terms and applicable bylaws of Blue Grass Energy Cooperative.

A Blue Grass Energy Representative will contact you should there be a question in establishing your account. Otherwise, your application for service will be processed immediately. You will be sent information that includes the necessary forms for you to complete. For residential and commercial accounts, please return these forms, along with any fees that you may be required to pay (membership and deposit, if applicable) to our office. For new construction accounts, if we have not acknowledged your request within two (2) working days, please contact our Engineering Department at 1-888-546-4243.

I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *