If you wish to reconnect electric service or transfer billing responsibility of an active electric service, please call our office during business hours:  7:30 am - 4:00 pm, Monday through Friday.  You MUST have the meter number available when you call. This 8- or 9-digit number can be found behind the glass of the meter at the location.  Please do not submit this form before contacting our office; you will need to provide your social security number prior to beginning this process.  All requirements necessary for your request will be disclosed to you at that time.

Claverack Rural Electric Cooperative, Inc. offers this electronic form to prospective 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.

For requests to reconnect electric service, this form and any other requirements (i.e. deposit, easement form, etc.) must be received at our office for processing. 

For requests to transfer billing responsibility of an active electric service, this form and any other requirements (i.e. deposit, easement form, etc.) must be received in our office within 30 days after the requested date to transfer billing responsibility to avoid disconnection of your electric service.

*** You will receive a confirmation message once all required information* is entered on this form and submitted.***

Membership Agreement & Application For Service
Applicant(s) Mailing Address
Prior Member of Claverack?
(Agree by checking.)
(Agree by checking.)
Applicant is:
If Tenant, Owner Name and Phone Number:
Intended Use of Service
Description of Service
Physical Address of Location Served:
A. PA Sales Tax Exempt - No Form Required
B. PA Sales Tax Exempt with Exemption #
(ex. 75 _ _ _ _ _ _ )
(ex. 76 _ _ _ _ _ _ )
C. PA Sales Tax Exempt - Exemption Form Required
This is one of the following: residence/retail business, retail business, non-charitable organization, campground business, rental property where electric is paid by landlord when rented/vacant
Type your name as you would sign it.
Type your name as you would sign it.
FOR OFFICE USE ONLY
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