PLEASE SIGN AND RETURN THE WHITE COPY TO
NORTH STAR ELECTRIC CO-OP
KEEP A COPY FOR YOUR RECORDS
APPLICATION FOR MEMBERSHIP IN THE NORTH STAR ELECTRIC COOPERATIVE,
INC.
AND APPLICATION FOR ELECTRICAL SERVICE
The
undersigned______________________________________________, hereinafter called
the "Applicant" and whose
mailing
address is _____________________________________________________________________,
in consideration of his/her being accepted as a member of the North Star
Cooperative Inc., hereinafter called the "Cooperative" and in
consideration of similar promises on the part of other Applicants and Members
of the Cooperative, agrees that:
1. Applicant will pay to the Cooperative a
membership fee of Five Dollars ($5.00) to be returned to Applicant if either
party elects to cancel this application by giving 30 days written notice.
2. Applicant will, at his expense, timely
clear the right-of-way for said line and obtain permits and approval of the
clearing from governing authorities. Rights-of-way will be subsequently
maintained by the Cooperative or its Contractor, either or both reclearing
and/or chemical treatment. Line construction will require a
contribution-in-aid-to-construction in accordance with Cooperative Policy.
3. Applicant will wire his premises in
accordance with wiring statutes and regulations in force in the State of
4. Applicant will purchase, when
available, all electrical energy purchased for the premises and will pay in
accordance with the By-laws and regulations now or hereafter pertaining thereto
and agrees to pay a monthly or annual bill for such electricity in accordance
with the rate applicable to the class of service as amended from time to time.
A deposit to guarantee payment of electric bill may be required. It is agreed
that the cooperative reserves the right to limit the amount of energy to be
furnished for any use.
5. Applicant will comply with and be bound
by the provisions of the Articles of Incorporation and By-laws of the
Cooperative and its rules and regulations and any future amendments of the
Articles of Incorporation or By-laws, present and future, but it is agreed that
Applicant, as a member, assumes no personal liability or responsibility for any
debts or liabilities of the cooperative, and it is expressly understood, that
under the law, his private property cannot be attached for any such debts of
the Cooperative.
6. This application may be accepted by the
Cooperative commencing the building of the proposed extension, evidenced by the
setting of the poles, installation, or delivery of material and equipment or by
formal acceptance by the Cooperative Board of Directors, whichever may be the
earlier. This contract shall be in force from acceptance until one (1) year for
the date service is made available and from that time forward until cancelled.
Applicant will provide the Cooperative with any easements that the Cooperative
deems necessary or convenient to construct the service and extend service to
prospective members.
Dated this
___ day of ___________ , 20__
X_______________________________________________ X________________________________________
Applicant's
Signature and SS#
Co-Applicant's
Signature and SS#
Home Phone
No. ___________________________ Business Phone No. ____________________________
Is Applicant
owner of this property? Yes__ No__
Signed In Presence of: X______________________________
(Witness)
DATA
COLLECTION INFORMATION
The Cooperative is required by the Federal
government to identify and document as accurately as possible the racial/ethnic
data on the population in our service area. We would appreciate your checking
the appropriate group listed below. Please note, your response is OPTIONAL. The
information you provide will be
used only for Federal Government reporting
purposes.
RACIAL/ETHNIC GROUP
__White (not of Hispanic origin) __American Indian or
Alaskan Native __Hispanic
__Black (not of Hispanic origin) __Asian or Pacific Islander