COMMERCIAL APPLICATION FOR MEMBERSHIP & ELECTRIC SERVICE

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.
Hidden
APPLICATION SUBMISSION DATE
MM slash DD slash YYYY
If working with a Nodak engineering representative on this project: (Select below)
Hidden
APPLICATION SUBMISSION TIME

: Hours

Minutes

AM/PM
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*
MM slash DD slash YYYY
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
MM slash DD slash YYYY
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
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:
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
Hidden
Operation Round-up Opt-in
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 Number*
Account Type*
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.*
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)
Hidden
Internal Use Only:
Hidden
Acct:
Hidden
Serv Addr:
Hidden
Serv Descript:
Hidden
Location #:
Hidden
Rate Class:
Hidden
Srv Order #:
Hidden
Prepared By:
CAPTCHA

COMMERCIAL APPLICATION FOR MEMBERSHIP & ELECTRIC SERVICE

NODAK ELECTRIC COOPERATIVE, INC.

COMMERCIAL APPLICATION FOR MEMBERSHIP & ELECTRIC SERVICE

PROPERTY INFORMATION FOR REQUESTED SERVICE

BILLING ADDRESS

PREVIOUS ADDRESS

PRIMARY MEMBER INFORMATION

LOCAL REPRESENTATIVE CONTACT

OPERATION ROUND UP

SECURITY DEPOSIT INFORMATION

AUTOMATIC PAYMENT INFORMATION

TERMS AND CONDITIONS

INDIVIDUAL COMPLETING APPLICATION

Internal Use Only: