Membership/Electric Service Application [v.1 July 2025]

Service Type*

New ConstructionExisting Service

Service Start Date

Date*

Meter #

Service Address*

Service Address

Street Address Line 2

CityState

Zip Code

How will services be used?*

Description of Structure Needing Service*

Applying as a(n):*

IndividualJointOrganization

Relation to Property*

OwnerRenterBuilder

Applicant Name*

First NameMiddle InitialLast Name

Applicant Date of Birth

Date*

Applicant Social Security Number*

Applicant Email Address*

example@example.com

Applicant Phone Number*

Phone number cannot start with 0 or 1.

Applicant Mailing Address*

Mailing Address

Street Address Line 2

CityState

Zip Code

Co-Applicant Name*

First NameMiddle InitialLast Name

Co-Applicant Date of Birth

Date*

Co-Applicant Social Security Number*

Co-Applicant Email Address*

example@example.com

Co-Applicant Phone Number*

Phone number cannot start with 0 or 1.

Organization Name*

TIN/EIN (provide SSN only if Business has no TIN or EIN)*

Email*

example@example.com

Mailing Address*

Mailing Address

Street Address Line 2

CityState

Zip Code

Primary Phone*

Phone number cannot start with 0 or 1.

Secondary Phone*

Phone number cannot start with 0 or 1.

Authorized Agent Name*

Last 4 of Authorized Agent's SSN*

Title/Position*

Authorized Agent Phone*

Phone number cannot start with 0 or 1.

Are you interested in Autopay/EFT/ACH?*

YesNo

Are you interested in Paperless Billing/E-Bill?*

YesNo

Are you interested in Pay-As-You-Go? (If Yes, an additional form is required)*

YesNo

Do you own a generator?*

YesNo

Do you own solar panels?*

YesNo

Do you own an electric vehicle?*

YesNo

Do you have life support system(s)? (If yes, a doctor's note will be required)*

YesNo

Are you interested in our rebate program?*

YesNo

By signing below, the undersigned ("Applicant") hereby applies for membership in and agrees to purchase electric energy from White River Valley Electric Cooperative, Inc. ("Cooperative") and agrees to the Cooperative's Standard Terms and Conditions of membership as amended from time to time, the most current version of which may be found at www.WhiteRiver.org.

The Cooperative cannot "guarantee" uninterrupted electric service to its members. Equipment failures, storms, accidents, scheduled maintenance, acts of God, and other events can, and do, result in loss of electric service.

The Cooperative will always attempt to keep power outages to a minimum, but outages may occur. Members having critical or sensitive equipment requiring electricity to operate (i.e. milking machines, computers, life-support systems, three-phase motors, etc should arrange for a backup power system (generator) to protect themselves and their property from damage.

Appropriate protective devices, such as surge suppressors or protectors, lightning arrestors, and line conditioners should be considered and utilized by the Applicant to guard against equipment or property damage caused by such events. Members with three-phase service, in particular, acknowledge that some outages can cause one or two "phases" to fail. When three-phase equipment operates on less voltage than designed, motors and equipment can be damaged. Backup generation and/or protective devices can help guard against these occurrences and are strongly recommended.

For safety reasons, our Engineering Department must be consulted if generators or any other electrical feeds are installed to supply electricity for the Applicant. The terms and provisions of this agreement apply equally to Applicant and all other Co-Applicants for this electric service.

Applicant Signature and Date

Signature*

Co-Applicant Signature and Date

Signature*

Authorized Agent Signature and Date

Signature*

CONSENT AND NOTICE REGARDING ELECTRONIC COMMUNICATIONS
WHITE RIVER VALLEY ELECTRIC COOPERATIVE
("WRVEC OR THE COOPERATIVE")

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a keypad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide WRVEC instructions via its website or in accessing or making any transaction regarding any agreement, acknowledgement, consent, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and WRVEC. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature constitutes your agreement to be bound by the terms and conditions of the WRVEC policies and agreements related to Electronic Communications as they exist on the date of your E-Signature and as subsequently amended by the Cooperative.

Consent to Electronic Delivery. You specifically agree to receive and/or obtain any and all WRVEC related "Electronic Communications" (defined below) via electronic mail from WRVEC. The term "Electronic Communications" includes, but is not limited to, any and all current and future notices, communications and/or disclosures that various federal and/or state laws or regulations require that we provide to you, as well as such other documents, statements, data, records and any other communications regarding your WRVEC membership, accounts or privileges. You acknowledge that, for your records, you are able to retain Electronic Communications by printing and/or downloading and saving this Agreement and any other agreements and Electronic Communications, documents, or records that you use with your E-Signature or receive electronically from the Cooperative. You accept Electronic Communications provided via WRVEC’s Electronic Communication system as reasonable and proper notice, for the purpose of any and all laws, rules, and regulations, including notices required by the bylaws of the Cooperative, and agree that such electronic form fully satisfies any requirement that such communications be provided to you in writing or in a form that you may keep.

Paper version of Electronic Communications. You may request a paper version of an Electronic Communication. You acknowledge that WRVEC reserves the right to charge you a reasonable fee for the production and mailing of paper versions of Electronic Communications. To request a paper copy of an Electronic Communication, please contact us at (417) 335-9335.

Revocation of electronic delivery. You have the right to withdraw your consent to receive/obtain Electronic Communications from the Cooperative. You acknowledge that WRVEC reserves the right to restrict or terminate your access to its Electronic Communication system or website if you abuse such system or privileges related to the Cooperative website, as determined in its sole and absolute discretion. If you wish to withdraw your consent, please contact us at (417) 335-9335.

Valid and current email address, notification and updates. Your current valid email address is required in order for you to provide E-Signatures and to obtain Electronic Communications from WRVEC. You agree to keep the Cooperative informed of any changes in your email address and to maintain a valid and current email address on record with the Cooperative. You may modify your email address by submitting a written request to WRVEC, by visiting a branch location, or by submitting a secure message through the WRVEC website. The Cooperative may notify you through email when an Electronic Communication or updated agreement pertaining to Electronic Communications is available. It is your responsibility to regularly check for Electronic Communications from the Cooperative and to check for updates to this Agreement posted online at whiteriver.org.

Hardware, software and operating system. You are responsible for installation, maintenance, and operation of your computer, browser and software. The Cooperative is not responsible for errors or failures from any malfunction of your computer, browser or software, nor is the Cooperative responsible for computer viruses or related problems associated with use of an online E-Signature system or receipt of Electronic Communications.

Controlling Agreement. This Agreement supplements and modifies other agreements that you may have with the Cooperative related to this subject matter. To the extent that this Agreement and another agreement contain conflicting provisions, the provisions in this Agreement will control on matters related to E-Signatures and the receipt of Electronic Communications. All other obligations of the parties remain subject to the terms and conditions of any other agreement.

To obtain services and receive electronic communications, indicate your consent to the terms and conditions of this agreement by clicking the "I Accept" box.

I Accept

Membership/Electric Service Application

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