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Application for Electric Service
Personal Application
Applicant*
First Name
*
Middle Initial
Last Name
*
Social Security Number
*
Driver's License Number
Date of Birth
*
Email
Home Phone Number
*
Cell Phone Number
Spouse or Second Applicant*
First Name
Middle Initial
Last Name
Social Security Number (Required)
Driver's License Number
Date of Birth (Required)
Email
Home Phone
Cell Phone
Billing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Service Address (if different than above)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Are you the property owner or renter?
Owner
Renter
If you are renting, please provide Landlord's name, address, & phone number.
Property Description
*
Full-time residence
Part-time residence (second home, seasonal cabin, garage, etc.)
Agricultural, commercial, or other
If "other" please describe:
Do you elect to be eligible for a discounted refund of patronage capital upon termination of membership as directed under #21 in the Membership Agreement?
*
Yes
No
Have you ever received electric service from ACEC before?
*
Yes
No
I wish to participate in Operation Round-Up
Operation Round-Up allows you to round your bill up to the next dollar amount to support community projects. More information available on our website.
Yes
No
By electronically signing, you are applying for and agree to become a member of ACEC and to accept all terms and conditions of membership as provided in the "Membership Agreement".
*
By electronically signing, you are applying for and agree to become a member of ACEC and to accept all terms and conditions of membership as provided in the "Membership Agreement".
I/We agree
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Comments
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Membership Agreement