Randolph Electric Membership Corporation

Randolph EMC uses various pieces of information such as your phone number and address to more quickly respond to your service needs. Our records of your phone number, mailing address and service address are listed on your bill each month. If Randolph EMC does not have correct information on your account, please complete this form so that we may better serve you.

Please note that this form is used only to modify your phone number, mailing address or service address. You must complete our Disconnect Service form to remove your name from an account or our Transfer Service form to move your service to a new location.

If you have any futher questions, you may contact us.

	*Indicates a required field.
	Current Billing Information:
	*First Name::
	*Last Name:
	Middle Initial:
	Suffix:
	*Address 1:
	Address 2:
	*City:
	*State:
	*Zip:
	*Email Address:
	*Phone Number:
	Account Number:
	New Mailing Address: (100 characters max)
	New Physical Address: (100 characters max)
	New Phone Number: