Average Payment Application Member's Name* Phone*Email* Account #* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Conditions of This Agreement Application can only be made for residential accounts. Applicant must have twelve months billing history at the above location. Account must have good credit record with no actual cutoffs or returned checks. Applicant must agree to receive usage information regarding their account. *Once you receive your first bill please call into Laurens Electric to familiarize yourself with the format of your statement. If you make any changes, additions, or experience any problems with appliances in your home after your account is on the program please contact LEC. This Agreement Is Subject To Cancellation At Anytime Due To Any Of The Following: Termination of electric service by the undersigned at the location listed above. Failure to pay full amount of Average Payment before the next bill is produced. Thirty days written notice by either party. Signature*PhoneThis field is for validation purposes and should be left unchanged.
