e-Bill Notification Member's Name * Required Phone * RequiredAccount # * RequiredLocation #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: * Required 2. Please check one: * RequiredI would like to receive only an E-bill notification.I would like to receive only a mailed copy.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 * RequiredEmailThis field is for validation purposes and should be left unchanged.