Builder Service Request

Builder Information

Name (First and Last) *

Business Entity Requesting Service *

Tax ID Number/EIN *

Please provide your OREMC member number *

Phone Number (Mobile) *

Email address: *

You acknowledge and accept the terms and conditions noted below. *

I accept the terms and conditions.

Please Specify

Signature required (type your name) : *

Today's Date *

By choosing to complete this Builder Service Request Form, you agree to the following terms and conditions. Your use of this Builder Service Request Form is conducted electronically and you agree that Okefenoke Rural Electric Membership Corporation may process all aspects of this electronic submittal the same as it would an "inked" document. You will be asked below to provide an electronic signature and date. By doing so you affirm and acknowledge that your electronic signature is legally binding. By initialing below and thereby affixing your electronic signature, you acknowledge that you have read Okefenoke REMC's Service Rules & Regulations and agree to its terms and conditions.

Builder Information

Service Location Address

Service Type

Terms and Conditions