This application and service agreement will make your electric service connection much easier.  Please fill out the entire form and one of our consumer services representatives will call if they require more information. Thank your for using our fillable form.

Application for Membership and Service Agreement (Residential)

  • 1 Sign & Submit Application
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Membership Agreements

Agreements
Empire Electric Association Membership Agreement

The undersigned (hereinafter called the "Applicant") applies for electric service and agrees to purchase electric energy from Empire Electric Association, Inc. (hereinafter called the "Association").

The Applicant agrees to pay the Association for service hereunder at the rates and upon the terms and Conditions set forth in the applicable rate schedule, available on request.

Applicants and guarantors agree to pay Association all costs of collections, including a reasonable attorney's fee, upon failure to pay for service in the matter herein agreed upon.

The Applicant shall provide absolute and unconditional guarantees for the term of this agreement, as deemed sufficient at the sole discretion of the Association.  All guarantees shall be continuing, absolute, unconditional, joint and several.  Guarantors waive presentment, demand, protest, notice of dishonor, all other notices, including the right to require the Association to bring action against the Applicant. 

An applicant who becomes a member of the Association will be bound by the Rules and Regulations, the By-laws, and provisions of the Articles of Incorporation. 

By agreeing to the terms of service, your membership is automatic.  If you choose to opt out of membership, please contact our office.

If you do not agree to a credit check when setting up an electric account, a deposit can be assessed. 

An applicant who chooses not to become a member of the Association will be bound by the Rules and Regulations, the By-laws, and provisions of the Articles of Incorporation.  Non members will not have voting privileges or benefit from the margins that may be returned as capital credits. 
I am 18 years of age or over.
If under 18 years of age, the online membership application will not suffice. A parent or guardian will have to sign the form in our business office at 801 N. Broadway, Cortez.
Service Connection
Is there currently solar, wind or hydro electric generation on this property? *
Are there additional electric services on this property?
Rental/Lease Confirmation
I, am renting/leasing the following property and authorize the Cooperative to connect service at this location. I am the primary tenant/resident at this address. I understand that misinformation regarding the service address may result in additional charges and/or interruption of service. I agree to provide further documentation to verify the information supplied above if requested by the Cooperative. I attest that I have reviewed all the information on this application and verified that it is correct.
I, am renting/leasing the following property and authorize the Cooperative to connect service at this location. I am the primary tenant/resident at this address. I understand that misinformation regarding the service address may result in additional charges and/or interruption of service. I agree to provide further documentation to verify the information supplied above if requested by the Cooperative. I attest that I have reviewed all the information on this application and verified that it is correct.
Property Owner Contact Information

If you are the property owner, please skip this section.  If you are renting or leasing this property, you are required to complete the property owner contact information section. 

Property Owner Name
Property Owner's Address

Member and Contact Information

Member Information
Applicant Info
Pdf is the best option for the upload. 
Upload requirements
Contact Information
Spouse/Co-Applicant's Info
Upload requirements

Location/Billing Information

Location & Billing Information
Service Address
Mailing Address Same as Service Address?
Mailing Address, if different from Service Address
If either account holder had a previous account with Empire Electric Association, Inc., please type their name(s).
Additional Authorized Account Contact
In addition to the account holder(s) listed, would you like to add another person who may access your account for balance information, to make payments, etc.? Only account holders may make changes to your account.

Sign & Submit Application

Authorizations
I understand that by typing my name in the field provided, it serves as my electronic signature.
I understand that by typing my name in the field provided, it serves as my electronic signature.
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