Senior Citizen Discount Application Senior Citizen Discount Application Applicant First Name * Applicant Middle Initial * Applicant Last Name * Member Account Number * Email Address * Phone Number * Birth Date * Address * Address Address Address 2 Address 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Senior Citizen Discount Terms & Conditions * I state under oath that I meet the following qualifications for participation in the Senior Citizen Discount Program. 1. My age is sixty-two (62) years or older.2. The electric service account is in my name for the above address. NOTE: Carroll EMC may audit the information provided in this document for verification. The applicant agrees to notify Carroll EMC immediately of any change that would make the applicant listed on this document ineligible for the Senior Citizen Discount Program. Captcha Submit If you are human, leave this field blank.
