Is this application for New Construction or an Existing Service?(Required) New Construction Existing Residential Services Name(Required) First Last Email(Required) Social Security Number(Required) Date of Birth (mm/dd/yyyy)(Required) Month Day Year HiddenDrivers License Number OLDDrivers License Number(Required) Drivers License State(Required) 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 Address(Required)If this is outside of our service area we cannot serve you. Street Address Address Line 2 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 Number(Required)Alternate Phone Number(Required)Is the mailing address the same as the address listed above?(Required) Yes No Mailing Address(Required)If this is outside of our service area we cannot serve you. Street Address Address Line 2 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 Are you currently employed?(Required) Yes No Employer(Required) Employer's Address(Required) Street Address Address Line 2 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 Work PhoneIf none, please enter your home number.Fax NumberSource of Income(Required) Name of person who last lived at the location of service First Last Meter Number at the Location Joint application?(Required) Yes No Joint Applicant Name(Required) First Last Joint Applicant Social Security Number(Required) Joint Applicant's Employer(Required) Joint Applicant's Employer's Address(Required) Street Address Address Line 2 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 Joint Applicant's Work Phone Number(Required)Do you own or rent the property?(Required) Own Rent Landlord's Name(Required) First Last Landlord's Address(Required) Street Address Address Line 2 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 Landlord's Phone Number(Required)Nearest Relative Not Living With YouNameRelationshipRelative's Address Street Address Address Line 2 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 Relative's Phone NumberWhich method would you prefer to use for determining the required deposit on this account?(Required) Online Credit Check (Ranges from $5 to $420) Neither (Pay Full Deposit $420) Prepaid Electric Service (Minimum $85 to start) Preferred Connect Date (mm/dd/yyyy)(Required) Month Day Year Driving Directions to Location from a major road or highwayConsent(Required) Terms & Conditions Agreement The Applicant hereby applies for membership in South Alabama Electric Cooperative, a corporation, its successors and assigns, (hereinafter called the Cooperative) and the Applicant and the Cooperative agree as follows: 1. The Applicant applies for membership and agrees to pay a membership fee of $5. A certificate will be issued to the applicant upon the acceptance of the application by the Cooperative. In case this application is not accepted by the Cooperative, the membership fee will be refunded to the Applicant. 2. When the Cooperative makes electric energy available to Applicant, Applicant agrees to purchase from the Cooperative and pay monthly to the Cooperative for all electric energy used by the Applicant, in accordance with the rate schedule and rules and regulations established by the Cooperative from time to time. The minimum monthly charge for service under this contract will be based on the applicable rate plus applicable taxes; or at such lawful rates as may supercede same. 3. The Applicant hereby grants to the Cooperative, its successors and assigns, the right and easement to construct, operate, repair and maintain on any lands owned by me and in or upon all streets, roads or highways abutting said lands, its electric distribution and service lines and appurtenances, and also the right to cut or trim trees necessary to keep them clear of all parts of the electric system. 4. The Applicant will cause his premises to be wired in accordance with wiring specifications required by the Cooperative. 5. The Applicant will comply with and be bound by the provisions of the Bylaws, rate schedules, rules and regulations of the Cooperative, as may be adopted or modified from time to time. The following is an excerpt from the cooperative's Rules and Regulations as they pertain to residential electric service. The Rules and Regulations can be viewed in their entirety at any of the cooperative's offices. Application for Service Each prospective member desiring electric service shall submit the Cooperative's standard form of Application for Membership and Service before service is supplied by the Cooperative Membership Fee A membership fee of $5 will be required. This membership shall not be transferable. Upon termination of service, this fee may be applied against any unpaid bills of the consumer and, if any balance remains, said balance will be refunded to the consumer. Should a person who is already a consumer of the Cooperative desire an additional service, this fee is still applicable except it shall be known as a service connection fee. Connection & Reconnection Fees A charge for meter connections or reconnections shall be made to all consumers. The charges are as follows: Meter Set Fee (New Service) - $30 Meter Set Fee (Existing Service) - $30 Reconnect Fee (Non-Pay) - $30 All routine connections shall be made during regular working hours. Deposits A deposit or suitable guarantee or security is required of any non-residential consumer before electric service will be supplied to insure prompt payment of bills. Deposits shall bear interest at the same annual rate as offered by the AmeriFirst Bank in Union Springs, Alabama for Passbook Savings. Rights of Access The Cooperative's employees or authorized agents shall have free access to the consumer's premises at all reasonable times for the purpose of reading meters, testing, repairing, removing, replacing or exchanging any or all of the equipment belonging to the Cooperative. If the wiring, fixtures or appliances in consumer's premises are found by the Cooperative's employees to be defective and liable to cause damage to the property of the Cooperative, the meter will be removed and service discontinued until such time as said defects are remedied. Consumer's Responsibility for Cooperative Property All meters, service connections and other equipment furnished by the Cooperative shall be and remain the property of the Cooperative. The member shall provide a space for and exercise reasonable diligence to protect the property of the Cooperative and shall reimburse the Cooperative for injury or damage suffered by it resulting from negligence of the consumer or from misuse of the property by the consumer or any unauthorized parties; and the consumer shall indemnify and hold harmless the Cooperative from all damage to person or property due to the installation, maintenance or operation of any electrical equipment on the premises or arising out of it in any way connected with the service furnished or to be furnished the consumer. Interruption of Service The Cooperative will use reasonable diligence to provide regular and uninterrupted service, but in case the supply of current should be interrupted or fail for any cause, the Cooperative shall not be liable for any damages resulting therefrom. Any interruption in service should be reported to the Cooperative immediately after it has been determined that the interruption is not caused by an open circuit or a blown fuse in the consumer's equipment. Telephone calls reporting power failures, other than those in the consumer's wiring and equipment, will be accepted by the Cooperative collect. Should the Cooperative refuse your collect call you can be assured they are already aware of the power failure. Notice of Unsatisfactory Service The member shall notify the Cooperative immediately should the service be unsatisfactory for any reason or should there be any defects, trouble or accidents to the Cooperative's equipment which would affect the supply of electricity. Such notices, if verbal, should be confirmed to the office in writing. Should Cooperative personnel be called to the consumer's premises and the cause of the power outage determined to be in the consumer's equipment, a service charge of not less than $5 will be made to cover the call. Special Charges In the event any special charges are incurred by the Cooperative above the normal cost of extending service to the consumer, the consumer shall be required to pay these charges in addition to the appropriate fees and energy charges. (Example: Acquisition of Right-of-Way, Railroad Crossing Agreement and Annual Charges and similar instances.) Billing Bills for service will be rendered monthly and shall be paid no later than 10 days from the billing date. Any such bill which is not paid within ten days from the date thereof shall then become delinquent at which time the appropriate late charge, as specified in the applicable rate, will be added to the account. The Cooperative may at any time thereafter, upon giving 5 days written notice, disconnect the service of the consumer. Bills shall be considered to be rendered and notices shall be considered to be given when left with the consumer or left at the premises when the service is rendered, or posted in the United States mail addressed to the consumer's last post office address. When a consumer's check used for payment of an amount due to the Cooperative is returned, the consumer's account shall be charged $30 plus bank charges. The consumer shall be put on notice in the manner described in Paragraph 1 above that if the check is not cleared up within 5 days, it will be handled as a delinquent bill. Any consumer giving the Cooperative 3 returned checks within any give 12-month period shall be put on notice that the Cooperative will no longer accept any checks for payment of their bills. However, after one year from the date the consumer gave his last returned check and the credit history of the consumer is good the Cooperative may again grant the consumer the opportunity to pay his bills by personal check. In the event the Consumer fails to pay the delinquent bill within the above-mentioned 5 days, the Cooperative may send an employee or collector to such consumer's premises for the purpose of collecting the bill or disconnecting the service. A collection fee of $30 to partly defray the collection costs will be added to and then become a part of the delinquent account. In the event such consumer fails to pay such delinquent account, service shall be disconnected unless the time for payment is extended as hereinafter provided. The Cooperative may extend at any time and from time to time, upon terms satisfactory to it, the time for payment of any such delinquent account, or any part thereof, and its action is so doing, whether by taking the note of the consumer or anyone else, with or without security, or merely extending the time for payment of such account shall be without prejudice to its right thereafter to disconnect service as above provided, and by so doing the Cooperative shall be held or considered as waiving its right, at its option, to disconnect service thereafter and to treat the contract under which the consumer is served as canceled and at an end. Meter Reading South Alabama Electric Cooperative will read all meters each month. If the Cooperative is unable to read the meter due to storms, locked gate, bad dogs or any other unusual circumstances, an estimated power use based on previous usage will be made for that month and will constitute the power used that month. Should it be determined that this estimate is too low or too high, a correction will be made on the next monthly bill. Termination of Service by Consumer Consumers who wish to discontinue service must give a notice in writing at least 5 days before termination is desired, unless a longer notice is required by any special contract they may be receiving service thereby. Termination of Service by the Cooperative The Cooperative may refuse to connect or may discontinue service for the violation of any of its rules and regulations, or for the theft of current, or the appearance of current theft devices on the premises of the consumer. This discontinuance of service for the above causes does not release the consumer from payment of minimum bills as set forth by the application for service. If the theft of current or the appearance of current theft devices are evident, the consumer shall pay a service charge plus an estimated billing for any current not registered through the meter plus any damages to the Cooperative's facilities. Service charges are $100 for the first offense, $200 for the second offense, $300 for the third offense. Employee Statements & Representations It is understood that no statement or representation of any employee or officer of the Cooperative shall bind the Cooperative unless the same be in writing and approved by the signature of the Manager or other designated official of the Cooperative and that no employee of the Cooperative is authorized to waive this condition. No Obligation to Consumer's Equipment The Cooperative in accepting the application of the consumer and in supplying energy does not assume any obligation or responsibility as to the condition of the consumer's equipment or apparatus. Rules & Regulations a Part of All Contracts This schedule of rules and regulations shall constitute a part of all contracts for receiving electric service from the Cooperative and applies to all service received from the Cooperative whether the service is based upon contracts, agreement, signed application or otherwise. A copy of this schedule, together with a copy of the Cooperative's rates and charges shall be kept open to inspection at its office at all hours of business. Revision of Rates, Rules & Regulations These rates, rules and regulations may be revised, amended, supplemented, or otherwise changed from time to time without notice. Such changes, when effective, shall have the same force as the present rates, rules and regulations. Tax Provision Cooperative rate schedules do not include any provision for the 4% tax on the cost of utility services purchased as imposed on the individual consumer by Act XXI of the 1969 Special Session of the Alabama Legislature. Bills shall be increased to offset this tax plus applicable proportionate parts of any other taxes, assessments, licenses, franchise fees or rentals which may hereafter be imposed upon the Cooperative by any government authority at rates higher than those in effect January 1, 1969 and which are assessed on the basis of meters, customers or the price of or revenue from electric energy sold. Power Cost Adjustment Cooperative rate schedules do not include any provision for a monthly energy cost recovery and rate stabilization factor as imposed under contracts for purchase of wholesale electric power. Effective May 1, 2003, the current monthly bill as calculated under any rate of the Cooperative shall be increased or decreased based on KWH usage as determined by the cost of power of Alabama Electric Cooperative, along with other associated costs of the Cooperative. This energy cost recovery and rate stabilization factor provides for the recovery by the Cooperative of defined energy cost and establishes a procedure for the recovery of defined energy costs through the base rate schedules of the Cooperative. However, the Board of Trustees may increase or decrease the monthly adjustment as it deems necessary to maintain the financial stability and integrity of the Cooperative. 6. The Applicant understands that an appropriate amount, not in excess of $6 of any funds accruing to him is to be used for an annual subscription to Alabama Living magazine and shall be paid for him by the Cooperative so as to reduce such funds in the manner as would any other expense of the Cooperative. The acceptance of this application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, its successors and assigns, and the contract for electric service shall continue in force from the date service is made available by the Cooperative to the Applicant, after which time either party may cancel this contract by written notice to the other party 30 days in advance. Please indicate below your acceptance of the terms and conditions as outlined above. Important: South Alabama Electric Cooperative is a member-owned utility. Therefore, membership is required to receive electric service. We cannot provide service to the requested location unless the terms of the membership application are accepted. 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.Applicant Electronic Signature (Full Name)(Required) Joint Applicant Electronic Signature (Full Name)(Required) CommentsThis field is for validation purposes and should be left unchanged.
