TRI-COUNTY Electric Cooperative, Inc.
"Taking Care of our Member-Owners"
Application For Membership & Electric Service
Page 1 of 2
Section 1 Electric Service Application
Billing Name and Address:
Name:
Address Line 2:
City:
State:
Home Phone:
Fax:
Place of Employment:
Date Service Desired:
Name:
Acceptance:
Section 2 TCEC Office Information Only:
Ownership:
Own:
Renting:
Total Electric Residence
Gas and Electric Residence
Temporary Service
Total Electric Mobile Home
Gas and Electric Mobile Home
Single Phase
Commercial Under 50 kVa
Industrial Over 50 kVa
Three Phase
Service Address:
Service Order Information:
Application Completed:
Address Line 1:
Account #:
Cooperative Employee:
Date:
Service Application Charges:
Reconnect Prior A/C:
Connect Charge:
ATC Charge:
Meter Pole Charge:
Letter of Credit:
Security Deposit:
Deferred Deposit:
The information 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 Origin)
Hispanic
Indian, American or Alaskan Native
Asian or Pacific Islander
1st PMT:
2nd PMT:
3rd PMT:
Total Balance Due:
Paid
Check
Cash
Money Order
In Office
By Phone
By Mail
In Field
Paid
Email:
Other Balance:
Map Location:
By Internet
Cycle: Meter #:
Driver's License Number & State:
Social Security #:
Spouse's Name:
Driver's License Number & State:
Social Security #:
Address:
City:
Zip:
Phone:
Name of Supervisor:
Member's Signature:
Date:
(With this signature, the Member has read and agrees to the conditions shown on the second page of this document)
Zip Code
Cell Phone
click to sign
signature
click to edit
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.
Azle Office
600 N. W. Parkway
Azle, TX 76020
(817)444-3201
(817)523-7231
1-800-FOR-TCEC
FAX:(817)444-3542
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.
Keller Office
4900 Keller Hicks Road
Forth Worth, TX 76244
(817) 431-1541 or 431-1542
1-800-FOR-TCEC
FAX: (817)431-9680
Seymour Office
419 N. Main
P O Box Drawer 672
Seymour, TX 76380
(940)888-3441
1-800-945-3077
FAX: (940)888-3820
Granbury Office
1623 Weatherford Highway
Granbury, TX 76048
(817)279-7010 or 279-7011
1-800-FOR-TCEC
FAX: (817)279-7012
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