Application for Service

Once the application, permit, and fee process has been completed, the connection of service can take up to 2 business days from desired date.  For security purposes, all social security numbers have been masked in the BECi System.

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

Today's Date:  
Type of Request:   *
Applicant:
First Name:		   *
Last Name:   *
Middle Initial:  
Social Security Number:--  *
Driver's License #:  *
License State:   *
Birth Date:  *  
Employer:  
Maiden name/Former last name:  

Mailing Address:
Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please enter the street address where service is required:
Service Address:   *
Service Type (Construction Required or Existing Service):   *
Parish of Service Address and Directions to Service Address:  
E-mail:  *
Confirm E-mail:  *
Primary Phone:--   *
Cell Phone:--   *
Work Phone:--   
Spouse/Cohabitant:
*ALL CO APPLICANT INFORMATION IS REQUIRED WHEN APPLICABLE. (If you do not have a spouse please enter N/A)		  *
Social Security Number:-- 
Driver's License:  
License State:  
Birth Date:    
Employer:  
Employer Phone Number:  

Online Account Access:
We offer a web portal and mobile app for access to your payment options, account management and easy access to your ebill. If you would like to access your account online, please create a password and password hint below. For security purposes, passwords must be combination of letters and numbers, and at least 8 characters in length.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Fee and Deposit Information:
A Membership Fee is chargeable only on the first service in a member’s name; additional services in the same name do not require membership fee. A security deposit will be required on all accounts and may be up to 2 ½ times the average monthly bill based on credit worthiness. Other fees may be assessed based on individual needs.

Membership Fee:  
Connection Service Charge:  

List person(s) authorized to access account(s):  
Service For (indicate Home, Mobile Home, APT, Farm/Barn/Shop, Camp or Church):  
Would you like to Connect a Yard Light at this location? (indicate yes or no)  
If yes, on existing pole or new BECi pole? (additional pole requires a $350.00 fee)  
Owner's Name:  *
Owner's Phone Number:  
Do you Own or Rent?   *
Please select your preferred billing method?   *
 
I have read and agree to the Terms of Service. By submitting this application request, I also agree that a credit check will be submitted to determine if a security deposit is required. A one time $5.00 membership fee applies.  I have read and understand the Permit Requirements.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *