Download the Residential Membership Application (PDF) Name(Required) First Last Driver’s License Number(Required)State(Required) Social Security Number(Required) Date (mm/dd/yyyy)(Required) Month Day Year Home Phone(Required)Cell PhoneEmail(Required) Spouse Name First Last Social Security Number Date (mm/dd/yyyy) Month Day Year New Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Service/911 Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Employer Work PhoneEmployer Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Length of Employment Relative not living with you Relationship Phone NumberDo you rent, buy or own your residence?(Required) Rent Buy Own Is this a house, a singlewide or doublewide mobile home, or other?(Required) Singlewide Doublewide Home Other Landlord Name Landlord Contact PhoneType of Heating(Required) Heat pump Furnance Natural gas Propane Other Is the water heater gas or electric?(Required) Gas Electric Have you received service from CVEC before?(Required) Yes No Please list previous account name(Required) Meter number at service location for verification of service addressMeter number must be provided by the customerIs there a second meter at this location that needs to be connected?(Required) Yes No If yes, provide the second meter number here:Would you like to be a SmartPay consumer?(Required) Yes No Upload Copy of Driver's License(Required)Max. file size: 300 MB.Consent(Required)Schedule of Membership, Deposits, and Fees: Membership $5. Security Deposits for Residential Accounts: Deposits are determined by an individual’s previous payment history with CVEC, if any, and credit score from On-Line Credit Services. If the individual leaves a bad debt with any previous utility, the deposit will automatically be $500. The following On-Line Credit Services scores determine the deposit: Score 0 to 10.9%: $ 0 Score 11 to 20%: $150 Score 20.1 to 25%: $250 Score 25% to Up: $500 SmartPay: $ 0 Security Deposits for Camper Units: Same as Residential Deposits Distribution Access Charge: Residential $40 Temporary Service Charge: Construction (Meter loop provided by consumer): $30 Carnivals, Revivals, etc.: Estimated Cost In and Out SmartPay monthly service charge: $6 Meter Test: (No service call charge to be used with discretion) $25 Service Calls (fault of the consumer only) Requested between 7 a.m. and 3:30 p.m: $25 Requested between 3:30 p.m. and 7 a.m: $100 Requested weekends and holidays: $100 Diversion of Current: (add estimated usage to Diversion of Current) $150 Unauthorized Cut Seal: $25 Late Payment Penalty: 10% of Net Bill Connect (Reconnect) Fee: $20 Disconnect (Requested) Fee: None Collection/Disconnect Fee: (Does not apply to SmartPay) For nonpayment $15 Reconnection Trip Fee: (Does not apply to SmartPay) For nonpayment Requested between 8 a.m. and 5 p.m. Monday to Friday: $ 25 Requested between 5 p.m. and 8 a.m. Monday to Friday: $100 Requested weekends and holidays: $100 Returned Check Charge: $30 Relocation of Service (Note: No charge if upgrade and additional load): Total Cost Billing: (Does not apply to SmartPay consumers) Bills shall be rendered to all consumers monthly. The term “month” shall be the period between any 2 consecutive meter readings. Members will be billed at the current approved rates plus applicable taxes and wholesale power cost adjustments. Bills submitted to customers will clearly define that the service is subject to be disconnected 5 days from the date the Delinquent Notice is postmarked. A late payment penalty will be imposed on all bills that are not paid or post marked by the due date. Delinquency: (Does not apply to SmartPay consumers) All bills are due 13 days from the date of the bill. A delinquent notice as stated on the invoice will include the following: Proposed Disconnected Date Disconnect Fee Reconnect Fee After Hours Reconnect Fee Additional Deposit– if disconnected for non-payment, an additional deposit will be accessed for each occurrence. $25 Collections: All accounts not paid will be processed for field collection if the bill is not paid by the delinquent date on your billing statement.SmartPay consumers will not receive a billing statement but are still responsible for paying all charges and fees associated with their electric service. All delinquent accounts are to be collected in full or disconnected unless the Cooperative is given evidence that the account has been paid or some error exists to justify nonpayment. The manager or his delegated representative has the authority to defer payment Diversion of Current: Diversion of Current will result in the following actions taken: Disconnect service immediately. Charge the account(s) a diversion of current fee. If meter is damaged, charge the consumer the latest purchase price of a like meter. The consumer must come to the cooperative office to resolve the account. The consumer must pay an additional deposit of 2 times their monthly usage based on the 12 previous months billing. The consumer must pay for all usage up to the disconnected reading. The consumer is to be informed that if all charges are not paid within 10 days, legal action will be taken. All of the above charges, plus any additional fees, must be paid before the consumer can be reconnected. Prosecution by a District Attorney may occur. In reference to the above diversion of current, Coosa Valley Electric Cooperative, Inc. reserves the right to institute criminal proceedings for the diversion of current and theft of services pursuant to section 13A-8-10.2 of the 1975 code of Alabama, as amended. The undersigned (hereinafter called the Applicant) hereby applies for membership in the Coosa Valley Electric Cooperative, Inc. (hereinafter called the Cooperative) and the Applicant and the Cooperative agree as follow: The Applicant agrees to pay the sum of $5 for membership in the Cooperative and the amount listed as meter deposit for electric service to Applicant’s premises. It is understood that upon termination of such service the membership fee and meter deposit, less any unpaid electric energy bills, will be refunded. Before service is initiated hereunder, Applicant will cause the premises to be served to be wired or re-wired, if necessary, in accordance with requirements and specifications of the National Electric Code (or other higher applicable standards), and agrees that all subsequent wiring of the premises will likewise be made in accordance with said codes. Applicant further, by submission of the application represents, covenants, agrees and warrants that all wiring, original and subsequent, is or will be prior to initiation of service, in full compliance with said codes and covenants and agrees to hold the Cooperative completely and absolutely harmless from any and all liability or responsibility for any property damage or personal injury sustained by applicant or any person or entity, caused by the wiring of the premises. When electric energy is made available to Applicant’s premises by the Cooperative and thereafter, Applicant will purchase from the Cooperative all electric energy used on Applicant’s premises and will pay therefor monthly for this service at the rates and upon the terms and conditions set forth in the applicable rate schedule of the Cooperative, and the same is hereby Incorporated herein by this reference thereto; it being understood, however, that said rates are subject to change from time to time in accordance with the actions of the Board of Directors and the By-laws of the Cooperative. Applicant agrees to, and does hereby, grant unto the Cooperative an easement for the construction and maintenance of the Cooperative’s power lines over, on, or across any and all portions of the property to be served hereby and any other property adjacent thereto owned by or under control of Applicant. Applicant will comply with and be bound by the provisions of the Certificate of Incorporation and By-laws of the Cooperative, and such rules, regulations and policies as may, from time to time, be adopted by the Cooperative. Applicant acknowledges receipt of copies of the current By-laws of the Cooperative. Applicant hereby agrees that $6 of the amount paid for electricity each year is for a subscription to the “Alabama Living” magazine. The acceptance of this application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative and the contract for electric service shall continue in force for one year from the date service is made available by the Cooperative to the Applicant and thereafter until cancelled by notice given by either party to the other at least 5 days in advance. The applicant agrees to and hereby authorizes the Cooperative to obtain and examine the applicant’s credit and employment history through On Line Credit Services, Inc. (Does not apply to SmartPay consumers). The applicant hereby waives the benefit of the right to claim exempt from execution of any property under the Constitution and the laws of Alabama, and any other state, and agrees to timely pay all charges for services rendered and upon the failure to pay all charges for services, rendered, the undersigned agrees to pay all cost of collections, including a reasonable attorney’s fee and interest costs. Property Damage Disclaimer Coosa Valley Electric Cooperative disclaims responsibility for damage incurred to driveways, septic-systems, water systems, lawns, trees or other obstructions while installing, at consumer’s request, security lights, poles, or additional underground or aerial electric service. It\ is the responsibility of the consumer to locate any underground water, sewage, gas, telephone service lines, septic systems and/or any other underground hindrances on the consumer’s property. In addition, the cooperative shall have the right to ingress to and egress from the premises at reasonable times and as required, shall have the right to cut and trim trees and shrubbery to the extent necessary to keep them clear of the electric lines. The cooperative shall use all reasonable care and diligence in clearing, re-clearing, and maintenance of right-of-way and electric distribution lines. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Member Electronic Signature(Required) Spouse Electronic Signature PhoneThis field is for validation purposes and should be left unchanged.
