Sign Up for Services

Please use this form to sign up to be included in a service or program provided as a member benefit by Adams Electric.

Type of Program:*

Project Helping Hand
Add Spouse (Joint Account)
Budget (Levelized) Billing

Name:*

Mailing Address:*

City:*

State:*

Zip Code:*

Phone Number:*

FOR ADD SPOUSE (JOINT ACCOUNT) ONLY:

Please add this name to my account:

Account Number:

FOR PROJECT HELPING HAND ONLY:

Please round up the account(s) I have listed:

Account Number 1:

Account Number 2:

Adams Electric Cooperative does not reveal any personal information that users provide to us through our Web site to any third party. All information provided by customers on this form is kept strictly confidential and secure to prevent unauthorized use of personal information.