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TRI-COUNTY Electric Cooperative, Inc. (Tri-County Electric Cooperative)

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TRI-COUNTY Electric Cooperative, Inc.
“A Commitment to Service and Savings”
Application For Membership & Electric Service
Section 1 Commercial Application Information:
Billing Name and Address: Requested Connection Date:
Business Name:
Address Line 1:
Address Line 2:
City: State: Zip Code:
Phone: Fax: Cell Phone:
Driver’s License No. & State: Social Security No:
Business Tax ID #: E-Mail Address:
Acceptance:
Owner / Officer Signature: Date:
(With this signature, the Member has read and agrees to the conditions shown on the second page of this document, and certifies all information provided by the Member on
this application is true and correct to the best of his/her knowledge. This completed application, signed by an authorized employee of the cooperative, shall sreve
as the members certificate of membership.)
Section 2 TCEC Office Information Only:
Ownership:
Own Renting, Owner’s Name:
Commercial Under 50kVa Industrial Over 50 kVa Temporary Service
Public Building Oil Field Irrigation Single Phase Three Phase
Other:
Map Location: Cycle: Book: Meter #:
Service Address:
Reconnect Prior Electric Service Account Number:
Service Order Information:
Application Completed:
In Office By Phone By Mail In Field By Internet
Service Order No: Account Number:
Cooperative Employee: Date:
Service Application Charges:
Membership Fee:
Duplicate A/C:
Connect Charge:
ATC Charge:
Meter Pole Charge:
Letter of Credit:
Security Deposit:
Deferred Deposit:
Other Balance:
Total Balance Due:
Paid Check Cash Money Order
The informarmation requested
under racial ethnic group is
used by Tri-County Electric
for the purpose of collecting,
analyzing, monitoring and
reporting on its equal
opportunity and affirmative
action efforts, including
reports filed with the federal
government under Title VI
of the Civil Rights Act of
1954, Section 504 of the
Rehabilitation Act of 1973,
and the Age Discrimination
Act of 1975.
VOLUNTARY
RACIAL / ETHNIC GROUP
White (Not of Hispanic Origin)
Black (Not of Hispanic Orgin)
Hispanic
Indian, American or Alaskan
Native
Asian or Pacific Islander
FAX:
The applicant (hereinafter called the "Member") hereby applies for membership in, and agrees to purchase electric
energy from Tri-County Electric Cooperative, Inc. (hereinafter called the "Cooperative") upon the following terms and
conditions.
The Member will pay the Cooperative the sum of $25.00 which will constitute the Member's membership fee.
The membership fee will be returned if all service is disconnected at the Member's request or if service is discontinued
because of violation of Cooperative operating tariffs.
The Member, by paying a membership fee and becoming a Member, assumes no personal liability or responsibility for
any debts or liabilities of the Cooperative, and it is expressly understood that under law a Member's private property
cannot be attached for any such debts or liabilities.
The Member agrees to purchase and pay for electric service in accordance with the Cooperative's tariff. Monthly, the
Cooperative will mail to the Member, a statement for service provided. Member agrees to pay the total amount shown
on the invoice within sixteen (16) days from its date of issuance.
The Member will comply with and be bound by the provisions of the Articles of Incorporation and By-Laws of the
Cooperative, and such rules and regulations adopted by the Cooperative's Board of Directors.
A Member may request that additional services be provided under a single membership. The Member shall be held
responsible for payment of all accounts opened under their membership.
The Member agrees that Cooperative personnel will be granted access to all fixtures and facilities used in the delivery
of electric service. The Cooperative and its personnel are authorized to perform maintenance,
right-of-way clearing, meter reading and system upgrades upon prescribed property as deemed necessary by the
Cooperative.
The Member acknowledges that all poles, wires, transformers and other facilities installed by the Cooperative on the
property described in the Electric Line Easement and Right-Of-Way, shall remain the property of the Cooperative.
Removal of previously mentioned equipment shall be at the option of the Cooperative upon termination of electric
service to said property.
The electric energy which the Cooperative agrees to furnish the Member may be limited, cut off, interrupted for repairs
and / or causes that may be deemed necessary by the Cooperative and where a known dangerous condition exists for
as long as the condition exists.
The acceptance of this application by the Cooperative shall constitute an agreement between the Member and the
Cooperative, and the agreement shall become effective on the date signed. If this agreement is for new construction,
the Cooperative shall commence monthly billing within ten (10) days of the completion date of the construction.
The Member understands that the Cooperative's primary distribution circuits offer single-phase protection only. Any
multi-phase equipment installed by the Member must incorporate the use of protective devices that will prevent
damage to the member's equipment should single phasing occur. The Cooperative will assume no liability for
equipment damage resulting from a single phasing condition.
The Member hereby grants to the Cooperative all rights, privileges and easements necessary or incidental upon all
roads, streets, or highways abutting said property to construct, operate, replace, repair and perpetually maintain
facilities used in the distribution or transmission of electric energy. The Member agrees to execute and deliver to the
Cooperative any conveyance, grant or instrument which the Cooperative shall deem necessary or incident for said
purpose. The Cooperative shall have the right of access to said facilities for repair and service upon discontinuance of
service for any reason, or to remove the same.
The applicant hereby assigns, transfers and sets over to the Cooperative the total book value of all capital credits
which are now or may hereafter be credited to his/her account on the books of the Cooperative, and which are or may
hereafter be available for retirement pursuant to proper action of the Board of Directors and the Cooperative, all such
amounts to become due and payable to the Cooperative two (2) years after the Cooperative shall have made a bona
fide attempt to pay said amounts to the party whose signature is upon this document and has not succeeded in doing
so.
Copies of your rights as a customer, electric service rates and tariffs relating to service are available to the Member at
each of the Cooperative's business offices shown below.
We welcome the opportunity to serve you and hope that you will take the time to familiarize yourself with the service
available through your Cooperative. If you have any questions please feel free to contact one of the Cooperative's
offices shown below.
Central Office
600 N. W. Parkway
Azle, TX 76020
(817)444-3201
1-800-FOR-TCEC
FAX:(817)444-3542
Northeast District Office
4900 Keller Hicks Road
Fort Worth, TX 76244
(817) 431-1541
1-800-FOR-TCEC
FAX: (817)431-9680
Southwest District Office
1623 Weatherford Highway
Granbury, TX 76048
(817)279-7010
1-800-FOR-TCEC
FAX: (817)279-7012
B-K District Office
419 N. Main
P O Box Drawer 672
Seymour, TX 76380
(940)888-3441
1-800-FOR-TCEC
FAX: (940)888-3820
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Completed 22 July 2021

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