New Construction Application - Multiple Service Locations

New Construction Application - Multiple Service Locations
Service Details
New Construction Type
Service Type
Service Address 1

Street Address

Street Address Line 2
CityStateZip Code
Service Address 2

Street Address

Street Address Line 2
CityStateZip Code
Service Address 3

Street Address

Street Address Line 2
CityStateZip Code
Service Address 4

Street Address

Street Address Line 2
CityStateZip Code
Service Address 5

Street Address

Street Address Line 2
CityStateZip Code
Service Address 6

Street Address

Street Address Line 2
CityStateZip Code
Service Address 7

Street Address

Street Address Line 2
CityStateZip Code
Service Address 8

Street Address

Street Address Line 2
CityStateZip Code
Date Requested

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Needed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant Information
Name or Business Name
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
SSN or Federal Tax ID
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Driver's License
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Business Fax
Email Address
example@example.com
Member Mailing Address (if different than Service Address)

Street Address

Street Address Line 2
CityStateZip Code
Co-Applicant Information
Name or Business Name
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
SSN or Federal Tax ID
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Driver’s License Number
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Business Fax
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
* All applicable areas must be completed. Incomplete applications will be returned.

If "Date Needed" section is not completed, the new service will be scheduled per HILCO's routine course of business.

** Credit worthiness scores will be utilized from Applicant Only.
Would You like to Participate in Operation Round Up
Every month, the additional pennies, nickels and dimes are added to a special fund to help organizations in our service area. A committee. representing all seven districts in HILCO's service area. will be responsible for deciding where the funds are to be allocated. Once the committee allocates the funds, selected community and charitable organizations will receive the proceeds. We will keep you informed on how much is collected and where the funds are distributed.
Signatures
By signing the application, I/we accept membership in HILCO Electric Cooperative, Inc.; authorize HILCO Electric Cooperative, Inc. to utilize third parties to acquire my/our consumer information, consumer reports, and credit worthiness scores for purpose of determining credit worthiness**; and agree to adhere to the bylaws and Tariff of the cooperative. I/We understand and agree that any credit granted shall be paid promptly in accordance with terms and agreements and that late fees may apply if payment is not received. I/We further understand and agree that in event of default, I/we will be responsible for reasonable collection charges, court costs, and/or attorney fees incurred to collect the debt.
Applicant's Signature
Applicant Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Co-Applicant's Signature
Co-Applicant Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

New Construction Application - Multiple Service Locations

Service Details

Applicant Information

Co-Applicant Information

Signatures