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.

Request For Additional Service
Applicant is:
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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