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Application for Service
NODAK ELECTRIC COOPERATIVE, INC.
RESIDENTIAL APPLICATION FOR MEMBERSHIP & ELECTRIC SERVICE
Please fill out form below and a member service representative will contact you to confirm your application.
If you need assistance, please call 1-800-732-4373 or 1-701-746-4461.
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APPLICATION SUBMISSION DATE
MM slash DD slash YYYY
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APPLICATION SUBMISSION TIME
:
Hours
Minutes
AM
PM
AM/PM
APPLICATION TYPE
*
I am applying for electric service to an existing home (apartment, house, etc.)
I am applying for electric service for construction of a new house and I am not a builder or contractor.
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Please indicate Nodak engineering representative you are working with on this project: (Select below)
*
Steve Breidenbach
Alex Spitsberg
Casey Hansen
Chad Neppel
Cole Johnson
Duddy Weisser
PROPERTY INFORMATION
Service Address
*
Unit/Apt./Suite
Service Description
*
Apartment
House
Farm
Bins
Shop
Tile Pump
Seasonal Cabin
Mobile Home
Other
Meter Number (if known)
City
*
State
*
North Dakota
Zip Code
*
Move-In / Close Date
*
MM slash DD slash YYYY
Do you own or rent/lease the service address listed above?
*
Own
Rent / Lease
Contract for Deed
Owner/Managment Company
Phone
Address
BILLING ADDRESS (WHERE YOU WISH TO HAVE YOUR ELECTRIC BILL MAILED)
Is the billing address the same as the service address?
*
Yes
No
Billing Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip Code
*
PREVIOUS ADDRESS
Do you currently have an active service with Nodak?
*
Yes
No
What is your current address serviced by Nodak?
Service Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you wish to have your current service disconnected?
*
Yes
No
Attention: Since you wish to have your current service disconnected you will be directed to the service disconnect form upon completion of the current form.
PRIMARY MEMBER INFORMATION
Have you had an account with us in the past?
*
Yes
No
What was your previous address that was serviced by Nodak?
Service Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
First Name
*
Middle Name
*
Last Name
*
Primary Phone
*
Is this a mobile phone?
Yes
No
Additional Phone
Is this a mobile phone?
Yes
No
Email
*
Social Security Number
*
Date of Birth
*
MM slash DD slash YYYY
Do you have a valid drivers license?
Yes
No
Drivers License State (Select One)
*
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Drivers License Number
*
ADDING JOINT MEMBER
If primary member desires to add a joint membership, please contact our office after completing application.
ACCOUNT SHARING INFORMATION
If primary member wishes for Nodak Electric Cooperative, Inc. to share account information with an individual (such as roommate, parent, or landlord), please indicate name and contact information below.
Name
First
Middle
Last
Phone
Birthdate (used to identify caller)
MM slash DD slash YYYY
Email
EMERGENCY CONTACT
NOT LIVING WITH YOU
Name
*
First
Last
Relation
*
Phone
*
OPERATION ROUND-UP
Operation Round-Up is a program where participating member’s bills are rounded up to the next dollar amount and the difference, averaging approximately $6.00 annually, is donated to worthy causes as dictated by a seven-member board quarterly. If you wish not to participate in the program, please indicate below:
I do not wish to help those in need by declining to contribute towards the Operation Round Up program
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Operation Round-up Opt-in
SECURITY DEPOSIT INFORMATION
A security deposit is required for all services and due immediately to receive electricity. Deposits for apartment occupants are $100 to $150, for new constructed services $200 to $300, and all other deposits are calculated as two-times the average bill, as determined by Cooperative. The deposit will be returned to applicant after 12 months of continuous good credit with cooperative. Deposits may be waived if applicant signs up for bank draft withdrawal through Nodak’s Automatic Payment Plan, upon receipt of a satisfactory credit report, has a 12-month favorable credit reference from applicant’s current power supplier, or has an existing account in good standing.
PAYMENT AND WAIVER OPTION FOR DEPOSIT (Select one)
*
**Clicking on an option will reveal details**
Enroll in Automatic Payment Plan
Allow Credit Check
Pay Deposit
Provide 12 month favorable credit history from applicant's current power supplier
**Automatic Payment Plan allows you to pay your electric bill without writing a check. Participants will still receive a monthly statement and payment will be automatically withdrawn from your bank account on or near the 25th of each month.**
**A member service representative will contact you with instructions**
**A member service representative will contact you with instructions**
Financial Institution
*
Routing Number
*
Account Number
*
Account Number
*
Account Type
*
Personal Checking
Personal Savings
Business Checking
Business Savings
**NODAK ELECTRIC COOPERATIVE, INC. WILL ACQUIRE MY CREDIT REPORT (SOFT CREDIT PULL) FOR THE PURPOSE OF DETERMINING IF DEPOSIT IS REQUIRED.**
TERMS AND CONDITIONS
Nodak Terms ________________ Applicant hereby applies for membership and agrees to purchase electric energy from Nodak Electric Cooperative, Inc., upon the following terms and conditions: 1. Applicant will pay monthly rates in accordance with the bylaws of the Cooperative. 2. Applicant will comply with and be bound by the provisions 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 Cooperative. A copy of Nodak’s articles of incorporation and bylaws are available upon request or at www.nodakelectric.com. 3. Applicant will pay the Cooperative a nonrefundable, non-transferable processing fee for each main meter location. 4. Any cosigner for the Applicant agrees to absolutely guaranty payment to Cooperative of any indebtedness owing should the Applicant default in the performance of any of the terms of his/her membership. Such guaranty by the cosigner is given in consideration of Cooperative’s extending credit to the Applicant under the terms of membership and any minimum commitment contracts entered into by the Applicant with the Cooperative. 5. The Applicant will grant to the Cooperative at its request the necessary easements to serve and supply electric power to the Applicant and other Cooperative members. The Applicant grants to the Cooperative the right of access to the Applicants property for purposes of service, installation and repair of electrical facilities. The acceptance of the application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, and the contract for electric service shall continue in force. 6. Monthly invoice may include off-peak electric heating and/or outdoor rental lighting charges. By submitting application I claim the information provided is correct, that I am the applicant, and have read and fully understand the above stated Terms and Conditions. Communications Terms _______________ Applicant (member) providing mobile phone number(s) represents that: 1) the phone number(s) belong to member only; 2) he or she agrees to accept calls and/or text messages from Nodak Electric (Cooperative), its agents and contractors concerning Cooperative business matters to a mobile (cellular) number through use of an automatic telephone dialer; 3) he or she authorizes Cooperative to leave a prerecorded and/or text messages in connection with any business communication the Cooperative initiates with member.
*
Nodak Terms
________________
Applicant hereby applies for membership and agrees to purchase electric energy from Nodak Electric Cooperative, Inc., upon the following terms and conditions:
1. Applicant will pay monthly rates in accordance with the bylaws of the Cooperative.
2. Applicant will comply with and be bound by the provisions 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 Cooperative. A copy of Nodak’s articles of incorporation and bylaws are available upon request or at www.nodakelectric.com.
3. Applicant will pay the Cooperative a nonrefundable, non-transferable processing fee for each main meter location.
4. Any cosigner for the Applicant agrees to absolutely guaranty payment to Cooperative of any indebtedness owing should the Applicant default in the performance of any of the terms of his/her membership. Such guaranty by the cosigner is given in consideration of Cooperative’s extending credit to the Applicant under the terms of membership and any minimum commitment contracts entered into by the Applicant with the Cooperative.
5. The Applicant will grant to the Cooperative at its request the necessary easements to serve and supply electric power to the Applicant and other Cooperative members. The Applicant grants to the Cooperative the right of access to the Applicants property for purposes of service, installation and repair of electrical facilities. The acceptance of the application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, and the contract for electric service shall continue in force.
6. Monthly invoice may include off-peak electric heating and/or outdoor rental lighting charges.
By submitting application I claim the information provided is correct, that I am the applicant, and have read and fully understand the above stated Terms and Conditions.
Communications Terms
_______________
Applicant (member) providing mobile phone number(s) represents that: 1) the phone number(s) belong to member only; 2) he or she agrees to accept calls and/or text messages from Nodak Electric (Cooperative), its agents and contractors concerning Cooperative business matters to a mobile (cellular) number through use of an automatic telephone dialer; 3) he or she authorizes Cooperative to leave a prerecorded and/or text messages in connection with any business communication the Cooperative initiates with member.
I agree to the terms and conditions
Signature
*
Additional Comments (optional)
By clicking the Submit button below, I understand that my identity may be checked with a credit-reporting agency to comply with the regulations under The Fair and Accurate Credit Transactions Act to help prevent Identity Theft as required by the Federal Trade Commission.
*
I agree
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Start, Move or Stop Service
SmartHub
Outages
Contact
My Co-op
About
Billing Policies
Capital Credits
Electric Rates
Employment Opportunities
Leadership
Legal Information
Meet Your Nodak Neighbors
PURPA 2023
Unclaimed Capital Credits
My Account
Account Information Update
SmartHub Overview And Signup
Start, Move or Stop Service
Sign up for Autopay
Payment Options
Payment Assistance
Understanding My Bill
Programs
Electric Vehicle (EV) Charging Program
Infinity Renewable Energy Program
Off-Peak Electric Heat
Operation Round Up®
RDFC Grant
Rebates
Youth Tour
Energy Information
Energy-Saving Tips
Load Management Status
Power Interruption Checklist
The Value of Electricity
News
Annual Reports
News And Events
Nodak Neighbor
Press Releases