Application for Residential Service

The Applicant, whose signature appears below, applies to the PETIT JEAN ELECTRIC COOPERATIVE of Clinton, Arkansas, (hereinafter called the "Cooperative") for membership and/or electric service to be supplied at the location herein described and, upon request, at any other location within the area served by this Cooperative. This agreement shall supersede and replace any previous agreement and shall apply to each location the Cooperative furnishes electric service to the applicant.

I hereby apply to Petit Jean Electric Cooperative for Membership and/or electric service with the Terms and Conditions (PDF).

I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.