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 Date of
Birth
______________________________________
________________________________________
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 _________________
For Office Use Only
Account Number __________________ Member Number _________ Deposit Required* ____ Amount _________
Verified Photo ID
________ Drivers License
Number ___________________
___________________________________________
________________________________________
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,