Application for Business Membership

Application for Business Membership

    Start Date of Service*

    Name of Business*

    Business Type*

    Address*

    Address Line 2

    City*

    State*

    Zip*

    Phone*

    Email*

    The applicant must supply a form for our files of any special or exempt tax rate in order for us to provide this special rate.

    The applicant agrees to the terms and conditions as stated in the By- Laws of the Cooperative which are in affect at the present time and which may change from time to time as adopted by the Cooperative.

    The applicant, by signing below, has the authority to act in behalf of this business in accepting responsibility for the electric bill on this account.

    Name (print)*

    Signature*

    Title*

    Date*

    Federal ID #*