Muscle Shoals Electric Board, AL - Residential Application for Service

Requested Turn On Date: Requested Turn On Date: / MM / DD YYYY
Applicant's Name: Applicant's Name: First Last
Applicant's Email Address:
Applicant's Cell Phone Number: Applicant's Cell Phone Number: - ### - ### ####
Applicant's Home Phone Number: Applicant's Home Phone Number: - ### - ### ####
Applicant's Date of Birth
Maximum of 10 characters allowed. Currently Entered: 10 characters.
Are you a citizen of the US?

Are you a citizen of the US? Yes No
Applicant's Driver's License Number:
Maximum of 12 characters allowed. Currently Entered: 0 characters.
State of Applicant's Driver's License:
Attach Driver's License: (File size is limited to 3MB)
Applicant's Social Security Number:
Maximum of 9 characters allowed. Currently Entered: 0 characters.
Attach Second ID: (File size is limited to 3MB)
Applicant's Employer: (Put Self if Self Employed or NA if Not Applicable)
Applicant's Employer's Phone Number: Applicant's Employer's Phone Number: - ### - ### ####
Applicant's Employer's Address: Applicant's Employer's Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
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