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Applicant*
First Name
*
Middle Initial
Last Name
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Social Security Number
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Driver's License Number
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Email Address
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 Address
Home Phone Number
Cell Phone Number
Billing Address
*
Street Address
Address Line 2
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Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
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Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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North Carolina
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Northern Mariana Islands
Ohio
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip
Are you the property owner or a renter?
Owner
Renter
If you are renting, please provide Landlord's name, address, & phone number.
Property Description
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Full-time residence
Part-time residence (second home, seasonal cabin)
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".
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