New Service ApplicationDate You Request Service to be Started (mm/dd/yyyy)(Required) Month Day Year Agreement(Required) The undersigned (hereinafter called the “Applicant”) hereby applies for membership in, and agrees to purchase one or more utility services from Community Electric Cooperative, (hereinafter called the “Cooperative”), upon the following terms and conditions: 1. The applicant will pay to the Cooperative the sum of $5 which, if this application/agreement is accepted by the Cooperative, will constitute the Applicant’s membership/agreement fee. 2. The Applicant will pay monthly for all utility services provided at rates to be determined from time to time in accordance with the bylaws of the Cooperative; provided, however, that the Cooperative may limit the amount of electric distribution service to be furnished for industrial applications. 3. Where applicable, the Applicant will cause his premises to be constructed and/or wired in accordance with local code requirements and the connection specifications approved by the Cooperative. The Applicant’s premise is approximately x feet from proposed distribution line and x feet from the nearest public road. 4. The Applicant will comply with and be bound by the provisions of the certificate of incorporation and bylaws of the Cooperative, and such rules and regulations as may from time to time be adopted by the Cooperative, including the donation of unclaimed capital credits as set forth in the bylaws. 5. The Applicant, by paying a membership/agreement fee, assumes no personal liability or responsibility for any debts or liabilities of the Cooperative and it is expressly understood that under the law his private property cannot be attached for any such debts or liabilities. The acceptance of this application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, and the Contract for the applicable utility services shall continue in force for one year from the date service is made available by the Cooperative to the Applicant, and thereafter until canceled by at least 30 days’ written notice given by either party to the other. Notwithstanding anything herein contained, the Applicant expressly agrees that the Cooperative may, prior to the acceptance of this application use the $5. If the Cooperative is unable to furnish 1 or more utility services to the Applicant, the sum of $5 will be returned to the Applicant. 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 signatureElectronic Signature (Full Name)(Required) Social Security Number(Required) Business InformationComplete Business Name(Required) Type of Business Entity(Required)i.e. Corporation, Sole Proprietorship, etc. Mailing 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 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 Federal ID Number(Required) Date Issued (mm/dd/yyyy)(Required) Month Day Year Contact Person(Required) First Last Phone(Required)Consent(Required)I certify that I am authorized to have the electric service in my name at this address 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.Commercial Load LetterService Location 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 Type of Business(Required) Member Name(Required) First Last Member 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 Member Phone(Required)Electrician Name(Required) First Last Electrician 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 Electrician Phone(Required)Type of Service(Required)Check all that apply Underground Service Change New Overhead Relocation Temporary Service InformationService Voltage(Required) 1 Phase, 3 Wire, 120/240 3 Phase, 4 Wire, Delta, 120/240 3 Phase, 4 Wire, Wye, 120/208 3 Phase, 4 Wire, Wye, 277/480 Other (Must be Approved) Total Square Footage(Required)Conditioned Square Footage(Required)Type of Heat(Required) Service Size(Required) 100 Amp 200 Amp 400 Amp 600 Amp Other Service WireSize of Load Phase Wire(Required) Sets of Load Wires Per Phase(Required) Size of Neutral Wire(Required) Load Wire Type(Required) Aluminum Copper Electric Load (No Motors)Indoor Lighting (kW)(Required)Exterior Lighting (kW)(Required)Electric Cooking (kW)(Required)Water Heater (kW)(Required)Dryer (kW)(Required)Heat Pump (kW)(Required)Emg. Strip Heat (kW)(Required)Electric Heat (kW)(Required)Air Conditioning (Tons)(Required)Computers (kW)(Required)Receptacles (kW)(Required)Refrigeration (kW)(Required)Other(kW)Other (kW)Other (kW)Future (kW)(Required)Electric Motor Load (Except Heat and AC)Electric Motor LoadPhaseNumber of MotorsHPVoltage Add RemoveOperating ScheduleHours per Week(Required)Months per Year(Required)Special NotesAgreement(Required) I hereby verify the information to be true and complete. 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.Electronic Signature (Full Name)(Required) Member InformationAccount 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 Mailing Address(Required) Same as previous 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 Rent or Own?(Required) Rent Own Landlord Name(Required) Landlord Phone(Required)Lease(Required) Drop files here or Select files Max. file size: 350 MB. Marital Status(Required) Single Married Divorced Separated Widowed Account Type Joint (only if married) Single Primary Account Holder InformationName(Required) First Last Social Security Number(Required) Driver's License Number(Required) Photo of Driver's License(Required)Max. file size: 350 MB.Date of Birth (mm/dd/yyy)(Required) Month Day Year Phone(Required)Email(Required) Employer Name(Required) Employer 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 Employer Phone(Required)Nearest Relative Name(Required) First Last Nearest Relative Address 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 Nearest Relative Phone(Required)Secondary Account InformationName First Last Social Security Number Driver's License Number Date of Birth (mm/dd/yyyy) Month Day Year PhoneEmail Employer Name Employer Address 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 Employer PhoneCooperative Living Magazine Digital SubscriptionEffective August 16, 1977 as per action of the Board of Directors, each applicant requesting service from Community Electric Cooperative desiring to receive the publication “Cooperative Living” will sign the following request as required by the Post Office for the mailing of this class of mail. The subscription shall be paid for each member by the Cooperative from any funds accruing in each member’s favor so as to reduce such funds in the same manner as would any other expense of the Cooperative. Subscribe Please enroll me in only receiving the digital copy of Cooperative Living Magazine.Mailing Address 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 Proxy CardName of Member Giving Proxy 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 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 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.Acknowledgement(Required) I hereby verify the information to be true and complete. 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.Electronic Signature (Full Name)(Required) PhoneThis field is for validation purposes and should be left unchanged.