Apply for Service - New Construction | Tri-County Electric Cooperative.

Primary Member Name

Primary Member Email

Primary Member Phone Number

Address

Address 2

City/Town, Illinois

ZIP/Postal Code

Primary Member's Employer

Primary Member's Business Phone Number

Joint Member Name

Joint Member Email

Joint Member Phone

Joint Member's Employer

Joint Member's Business Phone

New Construction Address or 911 address (if different from above)

Describe your request for new construction. (Examples: If residential (house, single-wide mobile home or double-wide mobile home, barn or shop). If commercial, roughly describe business type:

Examples: If residential (house, single-wide mobile home or double-wide mobile home, barn or shop). If commercial, roughly describe business type:

Is this a primary residence?

Yes, this will be my primary residence.

No, this will not be my primary residence.

If this location is a primary residence, you are eligible to receive a 50 gallon electric water heater voucher for $1. Would you like someone to contact you regarding the water heater program?

Please select your primary source of heat that you plan to install (if applicable):

Size of Service (if known)

I agree to the terms of service.

The undersigned hereby applies for membership with Tri-County Electric Cooperative, Inc. (MT. VERNON, ILLINOIS) and agrees to comply with and be bound by the provisions of the Charter and Bylaws of said Cooperative and such rules and regulations as may be adopted by the Cooperative.

Payment for electric energy shall include a subscription to the 'Hi-Lites', or its successor publication, published by the Cooperative and/or to the Illinois Country Living or its successor publication, published by the AIEC.

The undersigned hereby agrees to pay all costs of collection incurred by Tri-County in collecting any sum due for services provided, including without limitation, the charges of a collection agency incurred by Tri-County, which collection agency charges may be based upon a percentage at a maximum or 35% of the total debt, and also such other or additional reasonable attorney's fees incurred by Tri-County. I understand and acknowledge that Tri-County Electric Cooperative, Inc. will disconnect my electric service if provided information proves to be incorrect.

I authorize Tri-County Electric Cooperative to check with credit reporting agencies, credit references and other sources in investigating the information given.

I agree to pay the appropriate minimum bill for a period of twelve months beginning when the meter is set or sixty days after construction of service.

I understand that a deposit may be required contingent upon a credit check. A customer service representative will contact me to discuss my options.

Signature

Sign above

Joint Member Signature (if applicable)

Sign above