TALLAHATCHIE VALLEY ELECTRIC POWER ASSOCIATION

P O BOX 513

BATESVILLE, MS 38606

(662) 563-4742

APPLICATION FOR MEMBERSHIP AND ELECTRIC SERVICE
(Print, Complete, Notarize, and Mail or bring in this Application)

Name:		Spouse Name
Social Security #		Spouse Social Security #
Mailing		Service
Address:		Address:
Employer:		Spouse Employer:
Address:		Address:
Phone #	Home	Spouse phone #	Work
	Work

The undersigned (hereinafter called Applicant) hereby makes application for membership in the Association (hereinafter called the Association), and Applicant and Association agree as follows:

1. The Applicant agrees to pay the sum of $20.00 for membership subscribed for by Applicant.

2. When electric service is made available, Applicant agrees to pay a service charge of $30.00 and to purchase from the Association, and pay monthly for all electric energy used, as measured by Association’s meter, on applicable rate schedule. Applicant agrees to pay minimum monthly bill of $__________ per month whether or not the corresponding kilowatt hours is consumed.

3. The Applicant agrees to permit authorized agents of the Association free access to the premises of consumer for the purpose of inspecting, meter reading, repairing, or removing property of the Association.

4. Applicant will cause his premises to be wired in accordance with the provisions of the latest edition of the National Electrical Code.

5. Applicant will comply with and be bound by provisions of the bylaws and rules and regulations of the Association, as may be adopted from time to time. Copies of the bylaws and rules and regulations are available for inspection at the office of the Association.

Acceptance of this agreement between Applicant and Association shall constitute an agreement for electric service, and the contract will remain in force for ___________years from the date electric service is made available and thereafter until cancelled by written notice given by either party to the other at least thirty (30) days in advance.

Date	/ / 20	APPLICANT
Witness		Mailing Address
Notary
STATE OF
County of

Personally appeared before me the undersigned authority in and for the said County and State, ___________________

Who acknowledged that he signed and delivered the above Application for Electric Service, the day and year therein mentioned. Given under my hand and official seal of this _______day of ________,20____.

My commission expires _________________________________________