e-Bill Notification Member's Name* Phone*Account #* Location # Cycle # Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I, the undersigned member of Laurens Electric Cooperative, Inc. hereby request and make application to receive E-Bill notification via the internet. Conditions of This Agreement1. Please supply accurate e-mail address:* 2. Please check one:* would like to receive ONLY a mailed bill I would like to receive ONLY an emailed bill I would like to receive BOTH a mailed and emailed bill This Agreement Is Subject To Cancellation At Any Time Due To Any Of The Following: Termination of electric service by the undersigned at the location listed above. Member changes E-mail address without prior notifications of change. Thirty days written notice by either party. Signature*CommentsThis field is for validation purposes and should be left unchanged.
