Start Service (mm/dd/yyyy) Month Day Year Service(s) Needed(Required) Electric Service Natural Gas Service* (limited service area) Both* (natural gas has a limited service area) Name(Required) First Last Email(Required) Phone(Required)Last 4 Digits of Social Security Number(Required) Service Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mailing Address(Required) Same as Service Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code What is your preferred method you want us to communicate with you?(Required) Phone Email Joint Membership?(Required)A married couple may apply for a joint membership. The term “member” as used in the Code of Regulations shall include both married partners holding a joint membership and all provisions relating to the rights and liabilities of membership shall apply equally to the holders of a joint membership. Yes No Name(Required) First Last Phone(Required)Last 4 Digits of Social Security Number(Required) Are you the owner of this property?(Required) Yes No Name(Required) First Last Company(Required) Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Length of Lease (months)(Required) Operation Round Up By simply "rounding up" your electric bill to the next dollar each month, URE members can make a big difference in our community. To learn more visit our Operation Round Up page As standard procedure, URE rounds each bill up to the next highest dollar and collects the resulting change in a program called Operation Round Up. Funds are donated back to worthy causes in the community.Operation Round Up(Required) Yes, I'd like to participate in Operation Round Up No, I don't want to contribute to Operation Round Up Member Agreement & ConsentMember Consent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.The undersigned (hereafter called Applicant) hereby apply for membership in the Union Rural Electric Cooperative, Inc. and/or its subsidiary or affiliated companies (hereafter known as Cooperative) and agrees to be bound by the Cooperative’s Terms and Conditions for Supplying Electric Service and Terms and Conditions for Supplying Natural Gas Service and the following: Applicant will pay for all services at prices set by the Cooperative for services on or before the due date specified on the Applicant’s bill. Failure to do so may result in the Applicant being charged late payment penalties or result in discontinuance of service. Re-establishment of the Applicant’s service may require that all unpaid balances be paid in full along with a security deposit and other fees. Applicant designates the Cooperative as the Applicant’s agent for the purpose of entering into third party agreements to secure electric and/or natural gas supply, transmission and distribution services. Applicant agrees to be bound to and comply with the Code of Regulations and Articles of Incorporation as set and revised by the Cooperative Board of Trustees. Applicant agrees to maintain and properly use customer owned facilities and any apparatus connected to the Cooperative’s system, and agrees to identify and hold harmless the Cooperative against any injury, loss, or damage as a result of the use or misuse of customer’s facilities or apparatus. In no event shall the responsibility of the Cooperative extend beyond the point at which its service facilities are attached to the customer structure(s) on the premises to be served by the Cooperative. Applicant grants to the Cooperative the right to enter upon and an easement on, over, across, under and through any part of the premises to be served by the Cooperative to construct, install, operate, reconstruct, rephase, relocate, maintain, repair, and remove any part of the Cooperative facilities and/or communication systems for the purpose of providing all services applied for and to do all things incident or necessary thereto, including without limitation cutting, removal and controlling the growth of the vegetation that may interfere with or threaten to endanger the operation and maintenance of said system. Natural gas Applicants hereby acknowledge receipt of Terms and Conditions for Supplying Natural Gas Service As part of your cooperative membership, you will receive a subscription to Ohio Cooperative Living magazine. Applicant acknowledges and agrees that the Cooperative may review the Applicant’s credit history as a result of this application. Member Electronic Signature (Full Name)(Required) NameThis field is for validation purposes and should be left unchanged.
