Skip to main navigation.

Payment Extension Proposal Form

* Required

Account Info:


Contact Information:


Service Address:


Billing Info:


This proposal is subject to review and approval by the Habersham EMC Member Services Department. In no way does the submission of this form guarantee that the proposed extension will prevent disconnection of electric service. Please be sure to fill in all the blanks so that Member Services personnel may contact you. You will be notified if the proposed arrangement is acceptable or not.
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Target Image
Powered by Touchstone Energy Cooperatives Logo