Thank you for applying for service(s) with Altamaha Electric Membership Corporation/Altamaha Fiber. If you have any questions regarding new service, please contact member services (912) 526-8181. Please Note: We cannot guarantee same day service or connect service after office hours, on weekends or on holidays. All fields marked with an asterisk (*) are required.

Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
Please Select Services:      *
Applicant Information:
First Name:		   *
Last Name:   *
Social Security #:--  *
Driver's License #:  *
License State:  
Birth Date:
(mm/dd/yyyy format)		    

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

Service Address: (Physical 911 Address of Location)
Service Address:  
Additional Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:--   *
Cell Phone:--   *
Co Applicant Information:
Name:		 
Social Security #:-- 
Driver's License #:  
License State:  
Birth Date:
(mm/dd/yyyy format)		    

Member 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 using a combination of letters and numbers and create a password hint.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing Member:
Have you ever had service with Altamaha EMC?
*enter only digits that precede the dash (exp. 12345-001 should be entered as "12345")

    
Account Number:

Fees for Electric Service Include:

Membership Fee – $10.00
Establishment Fee – $15.00
Security Deposit – Based on results of credit check

Wish to waive your deposit?  Click here for more information on Pay Your Way Metering!

Fees for Fiber Service Include:

No Deposits are required.


Once your Electric and/or Fiber account has been officially created in our system, you will receive a new account information email, including a total amount due on your new account, also including deposit amount (if applicable).


REQUIRED For Electric Service Only:
Which type of billing option do you prefer? (Pay Your Way or Monthly)		  
Outdoor Lighting If there is an outdoor light at your location, would you like to keep it? (yes or no)  
REQUIRED For Electric and Fiber Service(s):
Do you own or rent the service location?		   *
Preferred Billing Method:
GO PAPERLESS, sign up for E Bill!		  
 
I agree to Altamaha EMC’s Bylaws, Terms and Conditions and Hold Harmless Agreement.  By submitting this application request, I consent to allow Altamaha EMC to run a check to verify that my social security number and the name on my application match. I also give Altamaha EMC express consent to send SMS text alerts, emails and phone calls to inform me of account activity such as billing and outages.  If my mobile phone number or email address changes, I agree to notify Altamaha EMC of these changes or update my account profile information through https://altamahaemc.com/.


Pay Your Way Metering Program:
I agree to the Terms and Conditions of the Pay Your Way Metering Program.

We will send you notifications showing your daily usage and balance.
You can manage your notifications and alerts at https://altamahaemc.com/.  To reach the member portal, click on "Member Login" at the top right side of the Home Page.

I agree to Altamaha Fiber LLC's ACCEPTABLE USE AND NETWORK MANAGEMENT POLICY, AGREEMENT FOR SERVICES, DISCLOSURE CONCERNING IP-ENABLED 9-1-1 SERVICES and Altamaha Fiber Privacy Policy. By submitting this application request, I consent to allow Altamaha Fiber to run a check to verify that my social security number and the name on my application match. I also give Altamaha Fiber express consent to send SMS text alerts, emails and phone calls to inform me of account activity such as billing and outages.  If my mobile phone number or email address changes, I agree to notify Altamaha Fiber of these changes or update my account profile information through https://altamahafiber.com/.

We will send you notifications and correspondence regarding your account. You can manage your notifications and alerts at https://altamahafiberemc.com/.  To reach the member portal, click on "Member Login" at the top right side of the Home Page.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Member Name:     *