Application for Membership and Electric Service Form Current Membership Agreement Primary Applicant Information Additional Contact Information (optional) Optional Service for Outdoor Lighting Signature Preview Complete 1 of 7 APPLICATION FOR MEMBERSHIP AND ELECTRIC SERVICE 103 INDUSTRIAL DRIVE NEW LONDON, OH 44851-9112 OFFICE: 1-800-533-8658 | OFFICE FAX: 419-929-8550 | EMAIL: billing@firelandsec.com | www.firelandsec.com The undersigned (hereinafter called the “Applicant”), hereby applies for membership in and agrees to purchase electric energy and distribution services to be used at the below-listed service address location (the “Premises”) from Firelands Electric Cooperative, Inc. (hereinafter called the “Cooperative”), upon the following terms and conditions: Applicant agrees to comply with and be bound by the provisions of the Articles of Incorporation and the Code of Regulations of the Cooperative and any amendments thereto, and such policies, rules, and regulations as from time to time may be adopted by the Board of Trustees of the Cooperative. The Board of Trustees or management is entitled to change, eliminate, or create new rules and regulations, at their discretion, without prior notice. Applicant authorizes the Cooperative to enter upon the Premises for the purpose of accessing rights-of-way and constructing, repairing, establishing, installing, maintaining, and removing electric facilities and equipment and/or other services, as deemed necessary or appropriate by the Cooperative. The Cooperative has the right to install, modify, or remove service extenders and remote disconnect switches at its discretion. Applicant shall cause the premises to be wired in accordance with the National Electric Code, and any other specifications that may be required by the Cooperative and shall indemnify and hold harmless the Cooperative against any claim, expense, injury, loss, or damage resulting from defect in or improper use or maintenance thereof. In no event shall the responsibility of the Cooperative extend beyond the point at which its service wires connect to the consumer’s service wires, as defined in the Cooperative’s policies, rules and regulations. SECURITY DEPOSIT A security deposit is required, except for residential services when the Applicant previously had an account with the Cooperative or with another electric supplier and was in good credit standing with no more than two late payments in a 12-month period or a Guarantor meeting the same qualifications has guaranteed payment of the account in the event the account holder is in default. A letter of verification from the previous electric supplier in the same name as the Applicant or Guarantor for the same class of service being requested is required if the previous electric supplier was not the Cooperative. Security Deposits for residential accounts will be refunded if the Applicant remains on the Cooperative’s lines for 24 months and has no more than two late payments in a 12-month period. In such cases, the Cooperative will apply the security deposit to the Applicant’s account on the 24th month of service. Other security deposits will remain with the Cooperative until service is discontinued, at which time the Cooperative, at its discretion, will apply credit to the Applicant’s final bill or issue a refund check. Security deposits from non-residential accounts will be retained by the Cooperative until such time that the account is closed. DUE DATE & PAYMENT OPTIONS Bills will be processed and sent by mail or electronically to the Applicant by the 28th of each month. Payments are due on or before the 14th day of each month and each Applicant shall pay, at rates fixed by the Board of Trustees of the Cooperative, all charges for electric and/or other services used at the Premises. The Cooperative offers an auto pay plan, which enables Applicant to have payments to the Cooperative automatically deducted from a checking, savings, or credit card account on the 14th day of each month. LATE CHARGES & OTHER FEES In the event Applicant’s payment is not received on or before the 14th day of each month, a late payment charge of 10% of the current bill will be applied to the Applicant’s account. In addition to all other available remedies, the Cooperative may discontinue service and, prior to resuming service, may require Applicant to pay for all electric previously used, other resulting charges, and/or make a security deposit. When a presented payment is refused by the bank or returned due to non-sufficient funds (NSF,) a returned check fee will be applied to the account. Other special service charges for disconnect and reconnect fees are posted in the Cooperative’s policy bulletin 8-8, which can be accessed on the Cooperative’s website. ASSISTANCE The Cooperative does NOT accept Percentage of Income Payment Plan (PIPP) energy assistance program. PIPP is only provided by regulated for-profit utilities that are subject to the rules of the Public Utilities Commission of Ohio. A listing of accepted energy assistance programs can be found on the Cooperative’s website. COMMUNICATIONS & COMMUNITY SUPPORT As a condition of membership, Applicant shall and herein does apply for a subscription to the Cooperative’s monthly publication, Ohio Cooperative Living, and agrees that the monthly charges for electric service shall include the cost of such subscription. The current rate for such subscription is $0.51 per month ($6.12 per year). Firelands Electric People Fund, Inc., is a 501(C)(3) non-profit charitable corporation also known as Operation Round Up, which is voluntarily supported by the Cooperative’s membership by having a member’s electric bill rounded up each month to the next whole dollar. Collected funds are then distributed through grants to local charitable organizations and individuals in need. Applicant’s average round up is just 50-cents each month, or $6 per year. Firelands members will be automatically enrolled in Operation Round Up unless they notify the office that they wish to be removed from the program. By signing this agreement, Applicant acknowledges and agrees the Cooperative has an easement to provide service to the Applicant and others, and the Cooperative has access to that easement. Upon request of the Cooperative, based upon reasonable terms and conditions, the Applicant agrees to grant to the Cooperative one or more written right-of-way easements for extending and furnishing service to the Applicant, or any other Cooperative member, or for any other need of the Cooperative in constructing, operating and maintaining its electrical system. The Applicant recognizes the Cooperative’s right to completely clear any rights-of-way of potential hazards to the Cooperative’s electrical system. The acceptance of this application by Firelands Electric Cooperative, Inc. will constitute an agreement between the Applicant and the Cooperative, and the contract for electric utility service shall continue in force until canceled by notice given by either party to the other. This form automatically saves. You may also save a draft and return to complete it later. Save DraftNext