APPLICATION FOR SERVICE UNDER THE VETERANS’ ORGANIZATION SERVICE
SPECIAL PROVISION ESTABLISHED BY N.J.S.A. 48:2-21.41
I hereby request that Rockland Electric Company (RECO) provides electric service under the Veterans’
Organization Service Special Provision at the following location:
Name of Applicant
Service Address
Account Number – Enter 10 Digit Account Number Shown on Bill
Contact Number Email Address
I certify that the location listed above is the primary location of the applicant. I further certify that applicant
satisfies the requirements for this service set out in N.J.S.A. 48:2-21.41 because it is an organization
dedicated to serving the needs of veterans of the armed forces and is one of the following: (1) chartered
under federal law, (2) qualified as a tax exempt organization under section 501 of the federal Internal
Revenue Code, or (3) organized as a nonprofit corporation under the New Jersey Nonprofit Corporation
Act. As proof of eligibility, attached is one of the following: (1) the organization’s Federal charter; (2) a
State of New Jersey “Exempt Organization Certificate” Form ST-5; or (3) an Internal Revenue Service
Determination Letter stating that the organization is exempt from Federal Income Tax under Section 501
(c) (19) of the Internal Revenue Code.
I understand that the submission of this application will not guarantee eligibility and that upon request by
RECO, I shall furnish further satisfactory proof of eligibility for service under this Special Provision.
I understand that I must notify RECO if the primary use of the location is no longer related to the
veterans’ organization identified above. I understand that RECO may make inspections at any time to
determine if the property is the location where the veterans’ organization primarily operates.
I certify that all information given in the Application is correct and also that any accompanying documents
are true copies.
Signature-Officer or Trustee of the Organization
Print Name
(Date)
Mail the application to the following address:
Rockland Electric Company
Customer Support Operations
390 West Route 59
Spring Valley, NY 10977
Or, submit the application via email to: ORCreditandCollections@oru.com
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