NODAK ELECTRIC COOPERATIVE, INC.

COMMERCIAL 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.

APPLICATION SUBMISSION DATE

APPLICATION SUBMISSION TIME

: HH

MM

PROPERTY INFORMATION FOR REQUESTED SERVICE

Service Address*

Unit/Apt./Suite

Type of Business*

Meter Number (if known)

City*

State*

Zip Code*

Move-In / Close Date*

Do you own or rent/lease the service address listed above?*

Own
Rent / Lease

OWNER OF BUILDING/PROPERTY*

Phone

Address

BILLING ADDRESS

Is the billing address the same as the service address?*

Yes
No

Attention/ Care Of:*

Billing Address*

City*

State*

Zip Code*

PREVIOUS ADDRESS

Does the commercial business currently have an active service with Nodak?*

Yes
No

What is your current address serviced by Nodak?

Service Address Address Line 2 City State ZIP Code

Do you wish to have your current service disconnected?

Yes
No

Date

PRIMARY MEMBER INFORMATION

Has the commercial business had an account with Nodak in the past?*

Yes
No

Business/Organization Name*

Federal Tax ID Number*

Primary Phone*

Is this a mobile phone?

Additional Phone

Is this a mobile phone?

Email

Communications Terms and Conditions*

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 Communication Terms and Conditions

LOCAL REPRESENTATIVE CONTACT

Name

First Last

Phone

SECURITY DEPOSIT INFORMATION

A security deposit is required for all commercial services and is equal to two times the average bill not to be waived or returned until service is discontinued. Existing commercial members with prompt payment history will not be charged a deposit for additional connected services. Deposits not paid within 30 days from move-in/close date may be subject to service disconnection.

AUTOMATIC PAYMENT INFORMATION

Do you wish to participate in the Automatic Payment Plan?*

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.

Yes
No

Financial Institution*

Routing Number*

Account Number*

Account Type*

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 through my participation in the Operation Round Up program

Operation Round-up Opt-in

TERMS AND CONDITIONS

*

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.

I agree to the terms and conditions

INDIVIDUAL COMPLETING APPLICATION

Name*

First Last

Job Title*

Phone Number*

Email*

Signature*

Additional Comments (optional)

Internal Use Only:

Acct:

Serv Addr:

Serv Descript:

Location #:

Rate Class:

Srv Order #:

Prepared By:

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