Member InformationMember Name(Required) First Last Email(Required) Phone(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 Is the application prepared by designated representative?(Required) Yes No Name First Last Company Email PhoneAddress 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 Generator & Interconnection Information The following information shall be supplied by the URE consumer-member or member’s designated representative. All applicable items must be accurately completed in order that the member’s generating facilities may be effectively evaluated for interconnection with the Cooperative’s Distribution System.Generator Primary Energy Input Source(Required) Solar Wind Other Please explain(Required) Generator Type(Required) Synchronous Induction Other Please explain(Required) Number of Generator Units Generator Model and Manufacturer Inverter Type Number of Inverter Units Inverter Model and Manufacturer Qualifying Facilities "Point of interconnection" electrical parameters: (Maximum net power productions capacity)Kilowatt Rating (95 degrees Fahrenheit at location) Kilovolt-Ampere Rating (95 degrees Fahrenheit at location) Power Factor Voltage Rating Ampere Rating Number of Phases Do you plan to interconnect the generator and operate in parallel with the Cooperatives electric distribution facility?(Required) Reduce Load Export Power Other Please explain(Required) What is the maximum amount expected? What is the estimated annual requirements for electric energy at this service address? (Kilowatt-hours) Expected Installation Date (mm/dd/yyyy)(Required) Month Day Year Expected Energizing and Start-up Date (mm/dd/yyyy)(Required) Month Day Year Please attach the one-line diagram(Required)Max. file size: 256 MB.Requirements & AgreementSign and submit the Member Agreement.(Required) Yes Do you have all the necessary government permits and approvals?(Required) Yes Layout sketch shows lockable, "visible" disconnect device(Required) Yes Generator manufacturer machine characteristics supplied to URE(Required) Yes Paid $100 non-refundable application fee(Required) Yes Member Consent(Required) I hereby verify the information to be true and complete. 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.Member Electronic Signature (Full Name)(Required) EmailThis field is for validation purposes and should be left unchanged.
