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

______________________________________                      ___________________________________

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 _________________

 

For Office Use Only

Account Number __________________     Member Number _________________     Deposit Amount ___________

 

 

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Cooperative Employee                                                                Date