Membership

The undersigned (hereinafter called the "Applicant") hereby applies for membership in Co-Mo Electric Cooperative, Inc., (hereinafter called the "Cooperative"), upon the following terms and conditions:

1. The applicant will comply with and be bound by the provisions of the Bylaws of the Cooperative, and such rules and regulations as may from time to time be adopted by the Cooperative. The Bylaws can be viewed online at www.co-mo.coop.

2. The Applicant will, when electric service is made available, purchase from the Cooperative all electricity purchased for use on the premises described herein and will pay therefore monthly at rates to be determined from time to time in accordance with the Bylaws of the Cooperative. The monthly availability charge begins upon completion of the line extension and/or meter installation.

3. Any default by the Applicant in the payment of his/her electric bills shall give the Cooperative the right to disconnect and remove the service and cancel this Membership. The responsibility of the Cooperative for furnishing electric service shall not extend beyond the meter.

4. The Applicant, as a condition of membership in the Cooperative, will grant an easement on and through their property to provide service extensions to self and other adjacent members as well as to perform necessary maintenance, service upgrades and periodic right-of-way re-clearing work.

5. The Applicant authorizes the Cooperative to make an investigation of their credit record through a credit agency or bureau of choice if needed.

IF NEW CONSTRUCTION IS NOT COMPLETED WITHIN (6) MONTHS, THE SERVICE REQUEST WILL BE CANCELLED AND ALL FEES PAID WILL BE DEDUCTED FROM ENGINEERING COST.

Applicant's Contact Information

Applicant's Name:*
Social/Federal ID (Last 4 Digits):*
Date of Birth/Incorporated Date:

Applicant's Contact Information Continued

Home #:*
Business #:
Mobile #:

Joint Applicant Contact Information

Joint Applicant:
Social/Federal ID (Last 4 Digits):
Date of Birth/Incorporated Date:

Joint Applicant Contact Information Continued

Home #:
Business #:
Mobile #:

Billing Address

Address:*
PoBox #
Apt. #
City:*
State:*
Zip:*

Physical Address

Address:
PoBox #
Apt. #
City:
State:
Zip:

Property Owner

Property Owner:*
Owner's Phone Number:*
E-mail Address:*