CompanyThis field is for validation purposes and should be left unchanged. Submission of this form does not guarantee service. A Habersham EMC Member Services Representative will contact you regarding this new construction application. Please be sure to fill in all the blanks and provide complete information to avoid delays. Please refer to the New Construction Checklist for information regarding construction requirements and process. If you have additional questions. For further information or questions, please call (706) 754-2114.Name(Required) First Last New Construction Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email Address Phone(Required)Additional Information & Comments
