Flint Energies - New Service Application

Please complete this form to apply for NEW service only. If you are currently a Flint Energies Member and wish to transfer your current service click here. If you wish to disconnect your Flint service AND are not transferring service to another Flint location, click here. All requests received after 1 p.m. will be processed the next business day.

Note: All fields with the asterisk (*) are required. Incomplete applications will not be processed. Information on this application will be used for the purpose of a credit check through Experian. Depending upon the results of your credit check, you may be required to pay a deposit in full, prior to electric service being connected.

Desired form of membership*:

Applicant Information
Name*:
Social Security Number*:
Home Phone*:
Work Phone*:
Cell Phone:
Drivers License #:
Date Of Birth(mm/dd/yyyy)*:

Spouse Information


Spouse Name:
Spouse Social Security Number:
Spouse Home Phone:
Spouse Work Phone:
Spouse Cell Phone:
Spouse Driver's License #:
Spouse Date Of Birth(mm/dd/yyyy):

Address Information


New Service Address*:
Apt #:
City*:          State*:          Zip*:    
Click here if Mailing Address is different from the above Service Address:   
Mailing Address:
Apt #:
City:          State:          Zip:    

Service Information
Service Start Date(mm/dd/yyyy):     Note:  Please allow us 24 business hours to connect service.
Type Of Establishment:
Subdivision Name:        Lot:        Block Number:       
Participate in Operation RoundUp:
Learn about Operation RoundUp here
I would like to receive my bill:
Email:   
I would like to pay my bill:

Click here for Bank Draft Form
Click here for Credit Card Form
If you are relocating to or within Houston County and would like to notify other utilities please check all that apply:

Contact Information


Name of person requesting service*:
Email Address*:
Phone Number*:

IMPORTANT READ CAREFULLY: The Membership Application requires that you agree to be bound by the Flint Electric Membership Corporation Articles of Incorporation, Bylaws, Service Rules and Regulations, Fee and Rate Schedules (Collectively the “Service Rules”) that appear on this page. Your agreement is a condition of membership and creates a legal agreement between you (a single entity or person hereinafter referred to as “Member”) and Flint Electric Membership Corporation (“Flint or Co-op”) that governs the terms of delivery of your electric service. By selecting “I Agree” below or if you otherwise receive electric service from Flint, you agree to be bound by the Flint’s Service Rules. If you do not agree to the Service Rules, you may not be connected to Flint’s system or you may be disconnected.

Having had an opportunity to read the Flint Service Rules, I agree