New Commercial Building – Natural Gas Questionnaire Step 1 of 3 0% This application is for service in our co-op territory only - Union County, OH, and the immediate vicinity.** NOTE TO APPLICANT: If your deed information is not available at this time, you may submit your application to begin the new service process. HOWEVER, this information MUST be submitted to URE and an easement created and signed by the property owner(s) BEFORE any URE facilities will be installed.**(Required) I AGREE to provide all necessary documents Please Select(Required) Sole Proprietorship Partnership Corporation Member InformationName(Required) First Last 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 Billing Address(Required) Same as previous 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 Phone(Required)Tax ID Number(Required) Are you the owner of this business?(Required) Yes No Property Owner Name(Required) First Last 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 Phone(Required)Email(Required) Builder/Contractor InformationBuilder/Contractor Name(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 Phone(Required)Email(Required) Service Requested Date (mm/dd/yyyy)(Required) Month Day Year Building Square Footage Gas Load InformationNatural Gas Service to be used for: Space Heaters Water Heating Food Prep Manufacturing Other Specify Other Total Load Given in Standard Cubic Feet per Hour (SCFH) OR Total Load Given in BTUH Delivery Pressure Required Appliance or Gas Burning Equipment Information(Click the + button to add a new row)Number of UnitsEquipment TypeBTU Input RatingOR Equipment Type (SCFH) Add Remove Load Forms or Construction Plans Drop files here or Select files Max. file size: 256 MB. Things to Do Before Site Meeting Complete set of final state/county-approved site plans with service entrance and meter locations marked, auto-cad of site plans Written legal description of the site and property as well as the survey map Complete a member application (if not already a member) application for electric/natural gas service signed and returned to URE Building corners/lot staked easements signed and grade sheet signed On-site meeting with URE/CERC construction and engineering representative Sign URE developers agreement and/or pay aid-to-construction charges Roadway and driveway crossing conduits installed to URE specifications All commercial: gas meter manifold may be built to your specifications at members expense. Member Signature & 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) EmailThis field is for validation purposes and should be left unchanged.
