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New Membership Application - Residential
The undersigned (hereinafter called the “Applicant”) hereby applies for membership in and agrees to purchase electric energy from Riverland Energy Cooperative (hereinafter called the “Cooperative”) upon the following terms and conditions:
The Applicant will, when electric energy becomes available, purchase from the Cooperative all electric energy purchased for use on the premises described below and will pay therefore monthly or annually at rates to be determined from time to time by the board of directors. It being understood that all amounts paid by Applicant in excess of operating costs and expenses of the Cooperative properly chargeable against the furnishing of such electric energy are furnished by him as capital. The Applicant will pay a minimum monthly or annual bill established by the board of directors for the class of service regardless of the energy consumed.
The Applicant will cause his premises to be wired in compliance with the Wisconsin State Electrical Code. The Cooperative reserves the right at its option to terminate electrical service if in the opinion of the Cooperative the condition of the wiring facilities is hazardous.
The 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.
The Applicant, by becoming a member, assumes no personal liability or responsibility for any debts or liabilities of the Cooperative, and it is expressly understood that under the law his private property is exempt from execution for any such debts or liabilities.
The Applicant will grant to the Cooperative a right-of-way easement to construct, operate and maintain an electric line or system over, under, and along land owned by the Applicant.
The Applicant consents and agrees to pay interest in such manner as the board of directors may specify on any past due accounts which may be deducted from any sums due the member or his survivor or estate.
Acceptance into membership of any person who is married shall automatically be deemed an acceptance of his or her spouse as a joint member unless such member directs otherwise in writing.
The Cooperative does not guarantee continuous and uninterrupted electric service and will not be liable for loss or damage to any member’s equipment caused by any failure to supply electricity or by any interruption or reversal of the supply of electricity if due to any cause beyond the reasonable control of the Cooperative.
The acceptance of this application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, and the contract for electric service shall continue in force for one year from the date service is made available by the Cooperative to the Applicant, and thereafter unless canceled by at least 30 days written notice given by either party to the other.
A $15 processing fee will be applied to your first bill.
By clicking Submit, I understand that I am applying for membership and electric service in accordance with the terms and conditions of this form. I understand that this also represents my digital signature.
Starting Service For:
- Select -
New construction
Existing service
Applicant Name
First Name
Last Name
Driver's License Number
Social Security Number
E-mail
Phone
Service Location Address
Location Address
City/Town
State/Province
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
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
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Billing Address
Billing Address (if different than location address)
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
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
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Joint Membership
Joint Membership
A
joint membership
has two names listed on the account and bill and is encouraged if there will be two people at the residence. Both people may inquire about account information or makes changes to the service. Although only one vote is allowed per membership, either may cast the vote. Both are entitled to receive any capital credit refunds issued to the account.
Joint Applicant
Joint Applicant's First Name
Joint Applicant's Last Name
Joint Applicant's E-mail Address
Joint Applicant's Phone
Joint Applicant's Drivers License Number
Joint Applicant's Social Security Number
Owner/Renter
- None -
Owner
Renter
Landlord
Landlord Phone
Type of Service
Primary Residence
Farm
Business
Seasonal
Date you would like service in your name
I agree to one of the following:
$100 Security Deposit
To be applied on my first bill.
Automatic Payment
Fill out the Auto Pay form and return it along with a voided check by fax, email, or mail, or provide email address and we will email your account number which is needed to setup your account. You can also setup Auto Pay online through SmartHub. Visit our homepage to get these forms and links *To sign up for SmartHub, you will need an account number. This number will not be available until your membership application has been approved.
Submit a letter of good credit from previous electric provider
Submit by e-mail or mail.
Prepaid Billing
Prepaid billing option allows you to pay our electric accounts as you choose. There is no deposit required, just a $50 minimum initial payment. You must have a SmartHub account, and cannot be enrolled in the Auto Pay program.
Upload Automatic Payment Form
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Upload Voided Check
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Upload Letter of Good Credit
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Community Cares Program
Community Cares
YES!
By checking this box, I am agreeing to enroll in the Community Cares program in which my bill will be rounded to the nearest dollar each month. The extra change will benefit needy charities in our local service territory in accordance with the guidelines set forth by the board of directors.
No, thank you.
I do not wish to participate in the Community Cares Program at this time.
Agreement
I understand that I am applying for membership and electric service in accordance with the terms and conditions of this form. I understand that this also represents my digital signature.
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