Stop Existing Service

STOP EXISTING SERVICE

Today's Date & Time

Date

Time

Account Number *

Type of Service to be Disconnected *

The Date you are requesting service to be disconnected

Applicant's Name *

First

Last

Last 4 digits of Social Security Number

Copy of Valid Drivers License *

Drag & Drop Files, Choose Files to Upload

Use this location to upload a copy of your DL. If you wish to provide this in a more secure manner, it can be brought by our business office.

Email *

Home Phone *

Mobile Phone

Work Phone

Name

First

Last

Service Street Address: *

City, State *

Zip Code *

Address to send Final Bill *

City,State *

Zip Code *

Additional Comments

Digital Signature *

Checking this box confirms the applicant has read and agrees to the below terms and applicable bylaws of Licking Valley Rural Electric Cooperative. A Licking Valley RECC Representative will contact you regarding your credit check and establishing your account. If we encounter any issues while conducting your credit check over the phone, you may be required to come into the office for verification. Your must pay all fees (membership and deposit, if applicable) to our office prior to your service being activated. For new construction accounts, if we have not acknowledged your request within two (2) working days, please contact our office at 606-743-3179.

Digital Agreement *

I understand that checking this box and typing my name in the field provided below is my electronic signature

Type your Full Name here to sign this Document Electronically.

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