Transfer Requested date (mm/dd/yyyy)(Required) Month Day Year Service Address(Required) 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 Upload proof of ownership(Required)Please provide a full lease in its entirety (including the signed pages), a copy of the deed, or a copy of your closing statement Drop files here or Select files Max. file size: 350 MB. Business Name(Required) Type of Business and Service(Required) Company Email Address(Required) Company Phone Number(Required)Company Fax NumberBilling Address(Required) 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 Authorized Agent(Required) First Last Direct Phone Number(Required)SSNIf a social security number is not provided to run a soft credit check, then a deposit will be required. Upload W9 Form(Required)Max. file size: 350 MB.Add an Additional Contact?(Required) Yes No Additional Contact Name(Required) First Last Additional Contact Phone Number(Required)Additional Contact Email Address Upload Copy of Driver's License(Required)Max. file size: 350 MB.Upload Operating Agreement/Bylaws(Required) Drop files here or Select files Max. file size: 350 MB. Name of the nearest neighbor(Required) Upload miscellaneous files(Required)(Load letters, site plans, etc.) Drop files here or Select files Max. file size: 350 MB. Add Additional Property Yes No Additional Property Address(Required) Street Address 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 Add Additional Property Yes No Additional Property Address(Required) Street Address 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 Upload proof of ownership(Required)Max. file size: 350 MB.Add Additional Property Yes No Additional Property Address(Required) Street Address 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 Upload proof of ownership(Required)Max. file size: 350 MB.Proxy CardName of Member Giving Proxy(Required) First Last Wheras, the Community Electric Cooperative, a Virginia Corporation, functions through its members and it is desirable to have all members or a large percentage of them present at annual and special meetings, or to have them properly represented so that the Cooperative will be in a position to act, and transact its necessary business, therefore, in consideration of membership in Community Electric Cooperative, Windsor Virginia, and the desire of the undersigned to be represented at meetings of members of said Cooperative, the undersigned hereby appoints: Proxy Choices A member of corporation in good standing The proxy committee as may be duly appointed from time to time by the Board of Directors of said Cooperative as his/ her or its proxy Name of Proxy To vote and act for the undersigned member at any regular or special meeting of the members of the said Cooperative at which the undersigned is not personally present. It is understood that the undersigned will vote in person when present, and that this proxy may be revoked at any time by notice in writing or request in person to the Cooperative, but this proxy shall remain in force from year to year until so revoked.Electronic Signature of Member Giving Proxy (Full Name)(Required) AgreementConsent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature. I agree that by signing this agreement, it is understood that the business is joining Community Electric Cooperative, Inc., and as a member of the cooperative it has certain rights and responsibilities. The rights include voting on bylaw changes and the Board of Trustees. The responsibilities include following the policies and bylaws of the cooperative, which can be found on the cooperative’s web-site The business agrees to pay for services in a timely manner, and it is understood that failure to pay will result in having services terminated. In the event that services are terminated, additional fees and deposits may be required to have services restored. The business agrees to grant the cooperative an easement for power lines for its service, as well as for additional services that might be located near to its service. In addition, it agrees to allow cooperative employees and agents to come upon my property to maintain and restore services. Part of that maintenance may include the cutting or spraying of bushes, shrubs and trees that may interfere with power lines. It is agreed, in order for us to service your account or to collect monies you may owe, Community Electric Cooperative, Inc., and/or our agents may contact the business by telephone at any telephone number associated with its account, including wireless telephone numbers, which could result in charges to the telephone owner. We may also contact the business by sending text messages or emails, using any email address that has been provided to us. Methods of contact may include using pre recorded/artificial voice messages and/or use of automatic dialing device, as applicable. The business agrees that Community Electric Cooperative, Inc., its employees and/or agents may contact it as described above. If you pay toward construction, the money you pay is a contribution- you are not purchasing the poles and lines for yourself, and therefore, you have no ownership rights in them; They are all owned and maintained by Community Electric. Therefore, if, in the future, other members desire to make a connection to the poles or wires for which you contributed toward the installation, you cannot prevent them from doing so, as you have no ownership rights in them, other than those same rights afforded to every Community Electric member. I hereby acknowledge and attest that all of the information that I have provided on behalf of the named business on this application is true and correct to the best of my knowledge. By signing below, I attest that I am authorized to execute this application on behalf of the applicant and have read and understand this application and its attachments.Electronic Signature (Main Applicant Full Name)(Required) NameThis field is for validation purposes and should be left unchanged.
