Application for Electric Service - Residential

This institution is an equal opportunity provider and employer.

A membership application signed by the applicant shall constitute membership if this application is accepted by the Cooperative.

The undersigned (hereinafter called the "Applicant") hereby applies for membership, and agrees to purchase electric energy from Cookson Hills Electric Cooperative, Inc. (hereinafter called "Cooperative"), upon the following terms and conditions, unless otherwise altered, amended or changed by separate special contract, which said special contract shall be controlling in case of conflict with any provision hereof.

  1. The Applicant will cause the improvements and facilities on said premises to be wired in accordance with wiring standards and specifications established by the city, town, and state safety codes, and in accordance with the most recent edition of the National Electric Safety Codes and National Electric Code. Applicant further agrees to cause such wiring to be inspected as required by any of the aforesaid codes or agencies, and will pay such inspection fees as are lawfully levied by the inspecting agency, and when such wiring is approved by the inspecting agencies concerned, Applicant will accept electrical service from the Cooperative.
  2. The acceptance of this application by the Cooperative, as hereinafter set out, will obligate the Cooperative to supply electrical service to Applicant, if electrical service is already installed and available at Applicant's premises. Thereafter such service shall continue until written notice of desire to discontinue service is given by either party to the other. After the discontinuance of service as aforesaid, or upon the discontinuance of service by the applicant without compliance with the aforesaid, and where the Applicant has been admitted to membership, such membership shall terminate.
  3. Applicant will comply with, and be bound by the provision of the Articles of Incorporation and Bylaws of the Cooperative and such rules and regulations as may from time to time be adopted by the Board of Trustees of the Cooperative or other authority having to do therewith, which said Articles of Incorporation, Bylaws, Rules and Regulations, and Terms and Conditions of Service between the parties hereto, are incorporated herein by reference, and made a part hereof, including all lawful amendments or changes that may be affected. A copy of said Bylaws is available and will be furnished to the Applicant upon request. It is further understood by and between the parties that all equipment, supplies, wiring, and other electrical facilities installed by the Cooperative upon Applicant's premises pursuant to this agreement, shall be and remain the personal property of the Cooperative, and Applicant hereby specifically authorizes the Cooperative to remove all of its said materials, supplies, equipment, wiring, and electrical facilities upon the termination of this agreement or upon the discontinuance of service.
  4. Applicant agrees and understands that in the event Applicant fails to pay the monthly bill (or such other period as the Cooperative may be billing) for electric and other services rendered by the Cooperative, within 10 days from due date, the Cooperative may, after a notice in writing is mailed or delivered to Applicant's residence (or place of business, if this is a business service), as provided by the Terms and Conditions of Service, and/or Bylaws of the Cooperative, terminate electric service to Applicant, and Applicant expressly releases Cooperative from any liability or damages incurred by Applicant as a result of such termination.
  5. The Applicant, by signing a membership application and becoming a member, assumes no liability or responsibility for any debts or liabilities of the Cooperative, and it is expressly understood that under the law, the Applicant's private property is exempt from execution for any such debts or liabilities. Further, the Applicant agrees to grant right-of-way easements and access to the Cooperative on Applicant's property upon request by the Cooperative to construct, expand, extend, operate and maintain its system as required by law and regulations governing the same. Applicant further agrees to grant unto the Cooperative the right to maintain any right-of-way and keep same free and clear from all obstructions, which may include, but not be limited to, manual cutting of trees, shrubs, foliage and all other forms of obstructions as well as chemical control thereof.
  6. The Applicant will, when electric service becomes available, pay therefore in monthly increments, at rates approved by the Cooperative's Board of Trustees. Rates may be lawfully altered, amended or changed by the Cooperative's Board of Trustees. Applicant hereby agrees that $3.48 of the amount paid for electricity each year is for a subscription to Oklahoma Living magazine, a monthly publication for the members of Oklahoma's Rural Electric Cooperatives. This charge is to apply to the Membership Account only.

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Please Read

The Applicant herewith pays to the Cooperative, the sum of $________________ of which $________________ shall constitute a deposit and $25.00 shall constitute a connect fee. If Applicant has good credit then the deposit will be waived. The deposit may be applied by the Cooperative to the payment of any account which shall remain unpaid by the Applicant. All the above fees will be refunded to Applicant if Cooperative is unable to supply electrical service to Applicant's premises described herein.

 

I have read the above paragraph *
Billing Cycle *
Account Name *
Co-Applicant
Mailing Address *
City *
State *
Zip *

911 Address (if different than above)
City
State
Zip
Home Phone *

Please include area code
Work Phone

Please include area code (+extension)
Cell Phone

Please include area code
Fax Number

Please include area code

E-mail *
Map Location
Meter Number
Which are you?

Property Owner's Name (if different from above)

First Name

Last Name
Have you ever received service from Cookson Hill's Electric Co-op?

If yes: Date Received
Name on Account

First Name
 

Last Name
Applicant Social Security Number *
Applicant Drivers License Number
Applicant Birthdate *
Co-Applicant Social Security Number
Co-Applicant Drivers License Number
Co-Applicant Birthdate
Marital Status





Maiden Name
If divorced, name of ex-spouce

First Name

Last Name

Name, Address, and Telphone number of two of your
nearest relatives not living with you.

Name of Relative 1

First Name
 

Last Name
Relative 1 Mailing Address
City
State
Zip
Country
Relative 1 Phone

Name of Relative 2

First Name
 

Last Name
Relative 2 Mailing Address
City
State
Zip
Country
Relative 2 Phone

Name of Employer

First Name
 

Last Name
Employer Mailing Address
City
State
Zip
Country
Employer Phone

Name of Co-Applicant Employer

First Name
 

Last Name
Co-Applicant Employer Mailing Address
City
State
Zip
Country
Co-Applicant Employer Phone
If no employment, give source of income

Optional

Cookson Hills is required by lenders to identify and document as accurately as possible the racial/ethnic data on the eligible population in our service area. We would appreciate your checking the appropriate group listed below. The information you provide will be used only for Federal Government Reporting purposes. Should you have any questions, you may contact the Cookson Hills Manager or a Member Services Representative at 1-800-328-2368.

Applicant Racial / Ethnic Group:






If other, please specify (Applicant)
Co-Applicant Racial / Ethnic Group:






If other, please specify (Co-Applicant)

Please read

I, the undersigned, do hereby acknowlede and understand that federal law prohibits me from removing a meter seal or disconnecting any Cookson Hills Electric Cooperative meter, survey or control device. Furthermore, I understand that failure to comply with this may be considered meter tampering, a crime punishable by fine and/or imprisonment. The minimum to reconnect such a device is $25.00

I have read the above paragraph *
Please select one or more of the following services in which you wish to participate:






If you choose Automatic Bank Draft or Fire Department Billing, you must complete the forms associated with each of those choices.  The forms are located under Service - SetUp Service.  Should you choose Automatic Credit/Debit Draft, you will be required to set up a Smart Hub account so that you can create the draft.

Please Read

To verify the amount required for a security deposit and to verify identity, the Applicant and/or Spouse/Co-Applicant do hereby authorize the Cooperative to run reports/identity checks, which requires the disclosure of Applicant's and/or Spouse's/Co-Applicant's social security number. I have authority to sign this agreement on behalf of my Spouse and/or Co-Applicant.

I have read the above paragraph *
Authentication Text *
security key
Please enter the code into the box on the left.