Please complete this form to apply for service with Panola-Harrison Electric Cooperative.  If you have any questions regarding new service, please feel free to contact our office during normal business hours (800) 972-1093.

Note: All fields with the asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Applicant Information:
First Name:
Last Name:   *
Social Security No.:--  *
Driver's License No.:  
Employer Information:
Street Address:  
Zip Code:  
Service Requested For:
Indicate Residence, Mobile Home or Other

Billing Address:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Physical 911 Address of Location

*place directions to the new location in the “Comments” field below if a 911 address isn’t available.
Service Address:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--  
Cell Phone:--   *
Employer Phone:--   
Co Applicant Information:
Social Security No.:-- 
Driver's License No.:  
Cell Phone:  

Online Portal Access:
We offer a portal for online bill payment and account management.  If you would like access to your account online, please create a password and password hint now for easy access to your account at  Please note passwords must be a combination of letters and numbers.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Member:
Have you ever had service with Panola-Harrison Electric Cooperative?

Account Number:

Fee and Deposit Information:

A $10 Membership Fee and a Connect Fee is required with the Application for Service. In addition, a security deposit may also be required. The deposit amount is determined based on a soft credit check and by existing history at the service location. Once your account has been created in our system, you will receive an email that will communicate the total balance due on your new account, including connect fee and deposit amount, if applicable. Please allow one to two business days to process your request. If this is an emergency please contact our office at 903-935-7936 (M-F 8am - 5pm) and ask for our New Services department.

Membership Fee:  

Prior Electric Service:
Utility Name:
Address Served:  
Dates of Service:  
Do you own or rent the service location?  
Please select your preferred billing method:   *
I, the undersigned, hereby agree to be bound by the terms and conditions, and the charter, by-laws, and rules of the Cooperative.  I further agree, that in the event of a default payment of any amount due, and if this account is placed in the hands of an agency or attorney for collection or legal action, to pay an additional charge equal to the costs of collection including agency and attorney fees, court costs, and administrative costs incurred and permitted by laws governing these transactions.
I understand that checking this box and typing my name in the field provided below is my electronic signature. I agree to receive text and/or email messages and reminders related to billing due dates, daily use and more.
  Applicant Name:     *