Wufoo

Please be advised that executing this Application online is optional. You have the right, if you so desire, to submit a paper application to the Cooperative located at http://westriver.com or apply at either office.

1.The applicant agrees to comply with and be bound by the Articles of Incorporation of the Cooperative, the Bylaws of the Cooperative, and any amendments thereto, and such rules, regulations, policies and rates as may be adopted from time to time by the Cooperative and applicant agrees that service may be denied or terminated for any reason allowed by the same.

2. The applicant agrees to provide a consumer deposit, if required, and understands that such deposit shall be interest bearing. At termination of service such deposit shall be applied to final bill and any remaining balance refunded after the next normal billing cycle.

3. Acceptance of application by the Cooperative shall constitute acceptance of applicant to membership with all rights and obligations. Membership shall terminate when electric service is discontinued. The Member assumes no personal liability or responsibility for the debts or liabilities of the Cooperative.

4. The applicant agrees to donate to the Cooperative any Capital Credit payments if the applicant or his/her heirs cannot be located with reasonable efforts.

5. Applicant agrees to provide, without charge, an easement in the form requested by the Cooperative over, upon,or underground on the applicant's property along the route or location determined to be most desirable by the Cooperative in order to enable the Cooperative to provide the requested electrical service to the applicant.

6. Applicant agrees to promptly notify the Cooperative and provide a forwarding address when applicant moves or service is no longer needed. Applicant agrees that failure to inform Cooperative in such circumstances may result in the applicant being held liable for any subsequent debt of the household until service is transferred to another party.

7. Applicant agrees to pay to the Cooperative all reasonable and necessary collection costs and attorney's fees in the event the Cooperative decides to employ a collection company or attorney to collect any amounts applicant may owe to the Cooperative.

8. Applicant agrees that when paying by check, they expressly authorize West River Electric Assn., the ability to electronically debit their checking account for the amount of the check. If the check is dishonored or returned for any reason, a processing fee not to exceed the state maximum legal limit, plus any applicable
sales tax, may also be debited from their account.

9. Applicant agrees that an annual subscription rate of $6.00 for the "Cooperative Connections", West River's official newsletter publication, shall be paid each year by each member from the amount accruing to such as capital credit on the records of the Cooperative.

10. Applicant agrees that WREA may contact applicant by phone, text or e-mail regarding all matters that pertain to my account and programs WREA offers. Applicant has the option to opt-out of phone calls.

11 I understand that if I am disconnected for non-payment and have a meter that has the ability to disconnect or reconnect electronically, the meter will reconnect when the past due amount on the account is paid.

12. Applicant agrees that any Capital Credits that will accrue to this membership may be used to satisfy any amounts owed by the member to WREA as Capital Credits are retired. *
Agree
Individual Member Information
Service Start Date * MM / DD / YYYY
First Name *
Middle Initial *
Last Name *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Home Phone Number * ### - ### - ####
Work Phone Number ### - ### - ####
Cell Phone Number ### - ### - ####
Social Security Number *

Your social security number is encrypted and secured.
Birth Date * MM / DD / YYYY
Joint Member (Optional)

All information must be filled in or joint applicant will not be processed.
First Name *
Middle Initial *
Last Name *
Social Security Number *
Birth Date * MM / DD / YYYY
Previous Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Has West River Electric Association, Inc. previously terminated or disconnected service to you because of nonpayment of a prior bill or are you otherwise currently indebted to West River Electric Association for electrical services? If yes, please explain.
List the names of all adult occupants of the residence for which you are requesting service.
I acknowledge that Capital Credits for a Joint membership shall constitute a Joint Tenancy with rights of survivorship.
Acknowledge
I acknowledge West River Electric Association's "Member Benefits Guide", online at http://westriver.com, which includes the Association's Denial of Service Policy, Bylaws, and Statement of Non-Discrimination. *
Acknowledge

The new member packet is available on West River Electric's website under the Customer Service tab. You can also request a CSR email you a packet when they contact you.
By Checking the AGREE box, I acknowledge that I am applying for electric service, and it is my intent to sign the Cooperative's Service Agreement electronically, and by submitting this document electronically I understand that this is the legal equivalent of having placed my handwritten signature on the document. I also represent that I have the authority to apply for service at this address and will abide by the terms of membership and electrical service. *
AGREE
Do Not Fill This Out

Wufoo

Individual Member Information

Joint Member (Optional)