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Request for Additional Service

This form is for current cooperative members who add one or more service locations to their original membership account.  Please do not submit this form before contacting our office.

Please fill in each required field and press the SUBMIT button.  You will receive a confirmation message once all required information* is entered on this form and submitted.

Claverack Rural Electric Cooperative, Inc. offers this electronic form to members of the cooperative for their convenience.  A hard copy of this form is available for completion at our main office or can be requested by mail.

Type your name as you would sign it.
Type your name as you would sign it.
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