New Member Service Application

Please complete this application to apply for new service. With this information, we will be able to set up your new account(s). If you have any questions about your upcoming service, please do not hesitate to call (361) 573-2428.

Please Note: If New Construction is required, 4-6 weeks lead time will apply.

All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant:
First Name:		   *
Last Name:   *
Social Security #:--  *
Driver's License #:  *
License State:  
Date of Birth: (mm/dd/yyyy)  *  
Employer:  

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

Service Address:
Select "Construction Required" if a meter is not present at the location or select "Existing Service" if a meter is already at the location.
Service Address:  
Service Type (Construction Required or Existing Service):   *
Meter ID #:
Click here for meter diagram		  
City, State & Description of where the service is located:   *
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Work Phone:--   
Joint Applicant:
Name:		 
Social Security #:-- 
Driver's License #:  
License State:  
Date of Birth: (mm/dd/yyyy)  *  
Employer:  

Online Portal:
We offer a variety of online services that our customers may use through our website. As one of our services, we provide an Online Portal for viewing and paying bills. Please specify an Internet Password and Password Hint at this time.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Service:
Have you ever been a member of VEC?    

Account Number:
*Please input only numbers before the dash. For Example: if your account# is 123456-001, input 123456

Fee & Deposit Information:
If you are not presently a member of Victoria Electric Cooperative, Inc. please arrange to have your current electric utility provide us with a letter of credit. With a good credit reference, we may not need a deposit to set up your service. The letter may be faxed to the attention of the Member Service Department at (361) 573-5753 or emailed to msr@victoriaelectric.coop. We require a $5 membership, $50 connet fee or a $25 transfer fee. When your account is created, you will receive an email with the total amount due on your new account, including the deposit amount, if applicable.

Membership Fee:  
Connect Fee:  

This service will be for a:
(indicate House, Mobile Home, Weekend Home, Water Well or Other)		  *
If Renting, Landlord's Name:  
If Renting, Landlord's Phone #:  
Do you rent or own the service location?   *
Please select preferred Billing Method:   *
 
By submitting this request, I certify that I have read and agree to the Terms and Conditions of the cooperative. I also agree that a credit check will be run to determine if a security deposit is required.

This institution is an equal opportunity provider and employer.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *