Irrigation Personal Application

Applicant*

First Name*

Middle Initial

Last Name*

Social Security Number*

Driver's License Number

Date of Birth*

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 City State Zip

Service Address (if different than above)

Street Address Address Line 2 City State 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*

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"

I/We agree

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Name

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Personal Application for Irrigation

Applicant*

Spouse or Second Applicant*