Personal Information

Name
Billing Address
Are you currently a CEC member?
Have you ever been a member of CEC?

Location Information

Service Location
Property Status
Ownership:
Upon completion of this form, a Member Services Representative will review your request and contact you to obtain your Social Security Number -- which is required to complete a credit check.

The results of the credit check may require a deposit to be paid prior to connection. 
Upon completion of this form, a Member Services Representative will review your request and contact you by phone to obtain your Social Security Number -- which is required to complete a credit check.

If the credit check is not completed within 48 hours of contacting you, the request will be canceled and you must re-apply by calling 800-521-0570. 

The results of the credit check may require a deposit to be paid prior to connection. 
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