ADAMS RURAL ELECTRIC COOPERATIVE, INC.

Application for Membership and Electric Service

 

     The undersigned, hereinafter called the “Applicant”, hereby applies for membership in and agrees to purchase electric energy from Adams Rural Electric Cooperative, Inc. hereinafter called the “Cooperative” upon the following terms and conditions.

·         The Applicant will pay the Cooperative the sum of $15.00, which if this application is accepted by the Cooperative, will constitute the Applicants’ membership fee.

·         The Applicant will, when electric energy becomes available, purchase from the Cooperative all the electric energy used on the premise described below, and will pay therefore monthly rates of the Cooperative, provided, however, that the Cooperative may limit the amount of electrical energy to be furnished for individual uses. The Applicant will pay at least the minimum monthly charge per the current rate schedule.

·         The Applicant will provide a valid right of way easement, up to forty (40) feet wide, at no cost to the Cooperative, allowing the Cooperative access to serve the Applicant and other members. The Cooperative shall be granted the right to perform necessary maintenance or upgrading to power lines or right of way and allowed access for meter reading purposes.

·         The Applicant will cause his service location to be wired in accordance with wiring specifications approved by the Cooperative. In no event shall the responsibility of the Cooperative extend beyond the point at which its service wires are attached to the meter provided for measuring electricity used on the Premises. The Cooperative shall not be responsible for the wiring of the Premises and any appliance or other apparatus connected thereto, and the Applicant hereby agrees to indemnify the Cooperative against, and defend the Cooperative from any claim of injury, loss, or damage from any alleged defect therein or improper use or maintenance thereof.

·         The Applicant hereby agrees that $4.68 of the amount paid for electricity each year is for a subscription to the Country Living magazine.

·         The Applicant will comply with and be bound by the provisions of the Charter and Code of Regulations of the Cooperative, and all amendments and additions thereto and such regulations and rules as may from time to time be accepted by the Cooperative.

·         The Applicant, by paying a membership fee and becoming a member, assumes no liability or responsibility for any debts or liabilities of the Cooperative, and is exempt from execution for any cost of liabilities.

 

              The acceptance of this application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, and this contract for electric service shall continue in force until cancelled by either party.

              Please provide all the information below, sign your name and return to our office along with the $15.00 membership fee.

 _____________________________                   ___________________________________

Applicants Signature                                               Social Security Number

______________________________                  ___________________________________

Please Print Name or D.B.A.                                  Phone Number

______________________________                  ____________________________                    

Service Address                                                      Billing Address                   

______________________________                  ___________________________________

City/State/Zip Code                                                 City/State/Zip Code

 

______________________________                  ___________________________________

Employer                                                                E-mail Address

__________________________________________________________________________

Other Information

Spouse __________________________     Spouse Social Security Number  ________________                                 

Owner ___     Easement _____________     Rent ____     Property Owner _________________ 

 

___________________________________________                     __________________________

Cooperative Employee                                                                           Date

           *  A. Credit Rating with Adams Rural Electric is not within the Cooperative’s allowable limit.

                B. Letter of Credit

_____Unable to supply a Letter of Credit from your current Electric Provider; or

_____ The Letter of Credit you have provided indicates more late payments than is allowable by the Cooperative.

C. Unpaid balance in the amount of $_________ owed on Account # ____________ that is/was in your name. This amount

      must be paid in addition to the Security Deposit in order to obtain service.      

NOTICE

     The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.  The federal agency that administers compliance with this law concerning Adams Rural Electric Cooperative, Inc. is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC  20580.