Application for Residential Membership

Application for Residential Membership

    Date of Service Requested*

    Marital Status*

    Type of Dwelling*

    Electric Service Address

    Street-Address*

    Address Line 2

    City*

    State*

    Zip*

    Name*

    Mailing Address*

    City*

    State*

    Zip*

    Home Telephone #

    Work Telephone #

    Cell Phone #*

    Other Phone #

    Social Security #

    Birth Date

    Driver’s License #*

    Issuing State*

    Employer/ Title

    Email Address*

    Spouse’s Name

    Cell Phone #

    Spouse’s Social Security #

    Spouse’s Birth Date

    Spouse’s Driver’s License #

    Issuing State

    Spouse’s Employer/ Title

    Spouse’s E-mail Address

    We require a valid ID. We accept several forms of identification as listed below. One of the primary IDs must be a photo ID.

    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.

    Each party, by affixing his/her signature below agrees to the above stated terms and conditions and agrees to accept full responsibility for the electric bill for this account.

    Date*

    Member Signature*

    Spouse Signature

    Property Status*

    Are you interested in your bill being automatically drafted?*

    Would you like to be set up with voice, email or text alerts for your account?*

    Cell Phone Provider

    Consent for Communication Regarding Termination

    I understand that my monthly bill provides the due date and the disconnect date. If payment is not received before 4:00 p.m. on the disconnect date, my account is subject to disconnection for non-payment. Powell Valley Electric Cooperative (PVEC) will attempt a courtesy call to the phone number listed on my monthly bill’s remittance stub if payment has not been received by the disconnect date.

    In the event that my account(s) is (are) on the termination list for non-payment, I elect and consent to be contacted using any available telephone number or email address provided to Powell Valley Electric Cooperative. I agree to promptly notify PVEC of any change in my contact information.

    Member Signature*

    Date*

    Alerts and Reminders

    Alerts and Reminders are available as an automated text, voice call, and/or email for additional notifications of account information.

    Text/call me on the following phone number

    Cellphone carrier

    E-mail me at the following e-mail address

    I would like to receive the following automated alerts & reminders: (select type of notice for each alert you wish to receive)

    Due Date Reminder TextCallEmail

    Arrangement Installment Due TextCallEmail

    Past Due Date Alert TextCallEmail

    Returned Check Alert TextCallEmail

    Payment Confirmation TextCallEmail

    **You may opt out of the Alerts and Reminders program at any time. Opting out of Alerts and Reminders does not prevent disconnection of service, only prior notification. **

    **TENANT NOTICE: In the event we are unsuccessful with the contact information provided on your account(s), we will attempt to contact you through your landlord prior to disconnection. (NOTE: Tenant should notify PVEC when moving.)**