Application for Service
Please complete the below application to apply for Residential, Commerical or Industrial service with Gallatin Department of Electricity. If you have any questions regarding new service, please feel free to contact customer service during normal business hours at (615) 452-5152 or send an email to customerservice@gdetn.com.

*Same day service is available for an additional charge. If same day service is being requested, please complete this form and contact our office.

Today's Date:  
Date Service is Desired:  *  
Type of Request:  
Applicant:
First Name:		   *
Last Name:   *
Middle Initial:  
Social Security Number:--  *
Drivers License Number:  *
License State:   *
Date of Birth:
Example format (xx/xx/xxxx)		  *  
Maiden Name:  
Name of Relative/Contact (not living with you):  *
Phone #:  *

Mailing Address:
*Please include unit #/suite if applicable
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please enter the street address where service is required: (Physical 911 Address)
Service Address:  
Apt # (if applicabe) or
Additional Comments:		  
E-mail:  *
Confirm E-mail:  *
Home Phone:
*if home and cell are the same, please enter in both field areas to ensure accurate correspondence		--   *
Cell Phone:--  
Work Phone:--   
Spouse or Co Applicant:
*all fields are required for Co Applicant
Name:		 
Social Security Number:-- 
Drivers License Number:  
License State:  
Date of Birth:
Example format (xx/xx/xxxx)		    
Maiden Name:  
Email Address:  
Other Phone:  
Electronic Signature: I understand that typing my name in the field provided is my electronic signature. *Required if Spouse or Co Applicant  

Online Access:
We offer a portal for ebill and account management. If you would like to access your account online, please create a password and password hint below.

Please note, the User ID must be alphanumeric (made up of both letters and numbers). In addition, your password must consist of the following: a minimum of 10 characters long, a combination of uppercase letters, lowercase letters, numbers, and symbols (!@#$%&*).
Customer Portal Password:  
Confirm Internet Password:  
Password Hint:


Connection Fee:
(Next/future day service fee)		  

Existing Service:
Do you have existing service with Gallatin Department of Electricity?		  *
If yes, please provide account number or service address:  
If transferring service, date to disconnect current address:
Example format (xx/xx/xxxx)		  
If currently on bank draft, continue using same bank draft information? (indicate yes or no)  
Do you rent or own the service location?   *
Please select your preferred Billing Method:
*if you choose to receive an EBill a Customer Portal Account must be created		   *
 
I/We are requesting electric service at the above address or any other location or premises occupied or designated, and as a condition of Gallatin Department of Electricity, hereafter referred to as GDE, providing the service, I/We understand the following: It shall be unlawful (1) to obtain or attempt to obtain, by use of any fraudulent means or methods, electric service with intent to avoid payment for the same; (2) to cause another to avoid such payment; or (3) to assist another in avoiding such payment through the making of multiple applications for service at one address, or otherwise.

It is understood that this application or agreement is subject to the Standard Rules and Regulations of GDE on file for inspection at the office of GDE and said Rules and Regulations are hereby made part of this agreement. I/We agree to be responsible for all current consumed at above address or any other location or premises occupied or designated, according to the rate of applicable.

By typing your name below, I/We understand that if the account is not paid in full after termination of electrical service at the above address, or any subsequent location to which service is transferred or established, I/We are responsible for all fees, including collection fees (an additional 35%) and/or reasonable fees, incurred for the collection of any unpaid bills. Also I/We agree to perform a credit check on credit performance through a reputable credit reporting agency to determine the applicable security deposit for the service address listed above.
“By checking the box, I agree and understand that my electronic signature is the same as if I came into the office and signed the application there. I also certify and affirm that it is my information or that I am representing this person or acting on their behalf with their permission and that this is a legally binding contract.”
  Applicant Name:     *