Membership Agreement & Application for Service



 

checklist

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 10 calendar 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 Form

Membership Agreement & Application For Service
Applicant(s) Mailing Address
Prior Member of Claverack?
Terms of Membership:

Applicant(s) hereby requests membership in Claverack Rural Electric Cooperative, Inc. (Cooperative) and agrees to purchase electric service from the Cooperative subject to the following:

1.    The applicant agrees to comply with and be bound by the provisions of the Articles of Incorporation, Bylaws and policies of the Cooperative as may be adopted or amended by the Board of Directors.  These documents are available upon request.  Bylaws and member policies are posted on the Cooperative’s website.

2.    Applicant agrees to grant and secure the necessary easements and rights-of-way to provide service to applicant’s property and other members free of charge.  Applicant further agrees that the Cooperative shall have access to the premises as necessary for right-of-way maintenance and the installation, replacement, repair and upkeep of such facilities of the Cooperative on the applicant’s premises as are necessary or appropriate in the Cooperative’s judgment to provide safe, adequate and proper electric service.

3.    Applicant agrees to pay for all electric service, applicable charges and required security deposits in accordance with and subject to the Cooperative’s Bylaws and policies.  Applicant agrees that the Cooperative may pass along charges associated with the collection of unpaid balances following the termination of electric service.

4.    It is agreed that membership in the Cooperative shall begin upon receipt of electric service.  Membership in the Cooperative shall cease upon termination of electric service.

5.    The Cooperative does not guarantee a constant, uninterrupted or regular supply of electrical service and shall not be liable for damages of any kind due to variations, interruptions or failure in electric service.

6.    Applicant agrees to receive autodialed or pre-recorded calls to any wireless or landline telephone numbers which have been provided to the Cooperative, regarding emergency notifications and/or informational notices such as planned outages, outage restoration, right-of-way clearing activity or other situations as they arise.

Member agrees to the foregoing on the basis of considerations provided to members as set forth in the Cooperative’s Bylaws, rules and regulations.

Claverack uses a credit reporting service to determine security deposit application.  Additional information can be found at www.claverack.com.
Cooperative Bylaws:

The Bylaws of the cooperative are available for review on this website under the "Your Co-op" tab or can be mailed by request.
Applicant is:
Intended Use of Service
Description of Service
Physical Address of Location Served:

Pennsylvania Sales Tax Determination:

Please review the different types of electric usage listed below and check which best describes how you will use electricity at your location. If an exemption certificate is required under Section C below, please provide one. If your tax status changes, it is YOUR RESPONSIBILITY to notify the Cooperative.

** CHECK ONE OR TAX WILL BE CHARGED **

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.