Date You Request Service to be Transferred into Your Name (mm/dd/yyyy) Month Day Year Consent(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) CommentsThis field is for validation purposes and should be left unchanged.
