Application for Electric Service and Membership

Applicant Information

Section 1: Applicant Information

Type of Membership

Individual(s)

Organization

Type of Account

Single

Joint

Title

First

Middle

Last

Suffix

Degree

Organization Name

Owner or Head of Organization

First

Last

Other Representatives of Organization

Other Representatives of Organization
	Other Representatives of Organization	Item weight

more items

First

Middle

Last

First

Middle

Last

Contact Information

Section 2: Contact Information

Service Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

I would like my bills sent to:

Same as Service Address

Different Address

Billing Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

I would like my board election ballot sent to:

Same as Service Address

Different Address

Member Address

Address Continued

City/Town

State/Province

ZIP/Postal Code

Country

Applicant(s) Date of Birth and/or Driver's License Number

Mobile Phone Number

For all, please use the format, XXX-XXX-XXXX

Land Line

Business Phone

Other Telephone Number

Member Email

Outage Email

Section 3: Property Information

Property Information

Are you purchasing this property?

Yes

Property Owner's Name

Property Owner's Phone #

Location has existing solar net meter system?

Yes

Confirmation

Section 4: Confirmation

I agree to the terms of service.

The Applicant(s) agree to be responsible for the electric charges at the location designated below until such time that the Applicant(s) request in writing a discontinuance of service. It is agreed that all bills will be paid by the appropriate due date and failure to do so may result in discontinuance of service. This application for electrical service shall constitute a service contract between the Applicant(s) and the Association. The Applicant(s) agree to be bound by the Rules and Regulations of the
Association. In the event that this application is not signed, it is agreed that the Applicant(s) use of electric service shall constitute a service contract just as though the application were signed. Applicant(s) agree to pay court costs, reasonable attorney's fees, and all collection costs if in default of this agreement. Applicant(s) agree that a facsimile of the original will be considered as valid as the original. The Consumer assumes all responsibility on the Consumer's side of the point of delivery for service supplied or taken, as well as for the electrical installation and
appliances used in connection with such service and will indemnify, save harmless and defend the Association against all claims, demands, cost or expense, for loss, damage to or injury to persons or property, in any manner directly or indirectly connected with, or growing out of, the transmission or use of electric service, by the Consumer, at or on the Consumer's side of the point of delivery. San Miguel Power Association
is not liable for any damage to the Consumer's electronic equipment. Point of Use surge protection should be installed to protect these.

Request Date for Service Hookup

NOTE: A Member Service Representative will contact you by phone or email in order to discuss deposit options.

Signature

Sign above

Second Signature

Sign above

Third Signature

Sign above

All new accounts are automatically enrolled in SMPA's Green Cents Roundup Program. For information on the Green Cents Roundup program and/or to opt-out of this program, please contact our office.

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