Online Signature Form for Phone Service Application

Member Information

Name(Required)

Prefix First Last

Social Security Number(Required)

Alias, Nickname, or Maiden Name

Birth Date (mm/dd/yyyy)(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Home Phone

Fax

Email

Do you have a co-applicant?(Required)

Yes
No

Name(Required)

First Last

Social Security Number(Required)

Alias, Nickname, or Maiden Name

Birth Date (mm/dd/yyyy)(Required)

Signature & Consent

Read the full Terms & Conditions of Service.

Terms of Agreement(Required)

AGREEMENT made this day between PEOPLE’S ELECTRIC COOPERATIVE (hereinafter called “Cooperative”) and Applicant (hereinafter called “Consumer”).

The Cooperative agrees to sell and to deliver to the Consumer, and the Consumer agrees to purchase and to receive from the Cooperative electric power and energy which the Consumer may need for service, upon the following terms:

Terms of Agreement

1. The Consumer will pay any and all service charges made for services rendered by the Cooperative at the Consumer’s request, and failure to do so is grounds for disconnection of service.

2. The Consumer shall become a member of the Cooperative, pay the membership fee and be bound by such rules, Bylaws, Terms and Conditions of Service, and regulations as may from time to time be adopted by the Cooperative.

3. The Consumer grants the Cooperative and our agents or contractors the authorization to contact the Consumer at any telephone number he/she provides, including wireless numbers, which may result in charges to the Consumer. Such contact may be made via an automatic telephone dialer, which may leave a prerecorded message, and/or such contact may be made via text messages to that number. This authorization shall remain in effect unless the Consumer provides a written request to opt out of such communications.

4. The Consumer shall pay the Cooperative for service hereunder according to the established Terms and Conditions of Service and applicable Rate Schedule(s), available upon request and made a part of this Agreement, which shall be subject to change from time to time as approved by the Board of Trustees of the Cooperative. Irrespective of the Consumer’s requirements for or use of electric power and energy, the Consumer shall pay the Cooperative the minimum amount per month established by the respective rate schedule, plus any adjustment as provided in the appropriate rate schedule. The minimum amount established by the rate schedule shall be subject to change from time to time as approved by the Board and shall remain in effect for the term of this Agreement. Should Agreement be cancelled prior to the end of the initial term, the minimum amount shall be due each month for the remainder of the initial term unless remaining term of Agreement is resumed by subsequent account holder(s).

5. This Agreement shall remain in full force and effect for an initial term of 12 months from and after the date service is first rendered hereunder and shall renew for subsequent corresponding terms.

6. MEMBERSHIP

The Consumer agrees to provide a security interest in his/her Capital Credits to secure payments of any amounts owed to the Cooperative as part of this agreement. Applicant hereby agrees that $5.64 of the amount paid for electricity each year is for a subscription to OKLAHOMA LIVING.

7. CONTINUITY OF SERVICE

a. The Cooperative shall use reasonable diligence to provide a constant and uninterrupted supply of electric power and energy hereunder. If the supply of electric power and energy shall fail, be interrupted, or become defective through an act of God, governmental authority, action of the elements, public enemy, accident, strikes, labor trouble, required maintenance work, inability to secure right-of-way, or any other causes beyond the reasonable control of the Cooperative, the Cooperative shall not be liable therefore or for damages caused thereby.

b. The Cooperative will use reasonable diligence to supply steady and continuous electric service at the point of delivery. The Consumer agrees to install and to be responsible for adequate protection devices to prevent damage to the Consumer’s electrical equipment. WARNING... The Consumer shall be responsible to install lightning arresters, surge suppressors, and such other equipment necessary to control voltage variations or partial power failure. The Cooperative shall not be liable to the Consumer for damages caused by reasons beyond the control of the Cooperative.

c. The Consumer shall not use the electric power and energy furnished hereunder as an auxiliary or supplement to any other source of electric power, except by special permission of the Cooperative. The Consumer shall not sell electric power and energy purchased under the terms of this Agreement. The Consumer will cause his premises to be wired in accordance with wiring specification approved by the Cooperative, but in no instance may the specifications be less than minimum requirements as specified by the National Electric Code.

The Consumer agrees that if at any time the rate under which the Cooperative purchases electric service at wholesale is modified or if any other charges are made to the Cooperative for electric power, the Cooperative may make a corresponding modification in the rate for service hereunder.

The initial period shall start when service is available hereunder.

Bills for service hereunder shall be paid at the office of the Cooperative, P.O. Box 429, Ada, Oklahoma, 74821-0429 or at other locations as may be designated by the Board. Such payments shall be due on the 10th day of each month for service furnished during the preceding monthly billing period. Should the Consumer fail to make timely payments as required in this Section, the Cooperative may discontinue electric service. SUCH DISCONTINUANCE SHALL NOT RELIEVE THE CONSUMER OF ANY OBLIGATIONS OF THIS AGREEMENT. Should the Consumer fail to make timely payments as required in this Section for two consecutive months, the balance of the Consumer’s minimum obligation shall become immediately due. This balance shall be the monthly minimum amount due to the Cooperative under Section 5 times the remaining months of the agreement less any deposit held on the account.

The Consumer hereby authorizes the Cooperative to perform an ACH draft of the Consumer’s checking or savings account via a telephone request by the Consumer. Any such draft request must be initiated by the Consumer, and all bank information must be provided by the Consumer at the time of each requested ACH draft.

8. SUCCESSION:

This Agreement shall be binding upon and inure to the benefit of the successors, legal representatives and assigns of the respective parties hereto.

9. RIGHT OF ACCESS:

The Consumer hereby grants to the Cooperative the right to enter, to construct, to remove, to reconstruct and to maintain necessary facilities in order to carry out the provisions of this Agreement. The Consumer shall obtain and furnish to the Cooperative necessary rights-of-way agreements to carry out the provisions of this Agreement. Any costs incurred in acquiring necessary rights-of-way agreement or land surveys necessary to locate electrical facilities shall be paid by the Consumer prior to the construction of such facilities. The Cooperative shall have the right to cut and to remove trees and shrubs and to maintain the rights-of-way by chemical means without liability to the Cooperative for damages.

10. LIABILITY:

The Cooperative shall not be liable for any damages due to delays in making service available to the Consumer caused by unavailability of materials, the inability to obtain right-of-way for construction, delays in construction schedule, storms or any other cause beyond the control of the Cooperative.

The Cooperative further shall not be liable for any damages that result from either service connection or disconnection of account as a result of untimely payment or collection issues.

11. OWNERSHIP:

Every extension hereunder shall at all times be the property of the Cooperative, regardless of whether a deposit or contribution is made in aid of its construction.

12. GOVERNMENT AUTHORITY:

The Contract and all rates, rules, regulations, terms and conditions of service, bylaws and other matters, either a part of this contract or referred to herein, are made with the understanding that the same, or portions thereof, might be changed by any State, Federal, or local governmental authority having jurisdiction to make said changes according to law.

13. AUTHORIZATION:

The Consumer authorizes the Cooperative to request, receive, and/or evaluate any written, oral, or other communication of information from a consumer reporting agency, financial institution, or other individual or entity regarding Consumer’s worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which the Cooperative might use or collect to establish, wholly or partially, Consumer’s eligibility for past, present, or future extension of credit, which the Cooperative might use in connection with a past, present, or future credit transaction, or which the Cooperative might use to review or collect a past, present, or future account, associated with the Cooperative providing service.

14. MEDIATION:

If a dispute arises out of, or relates to, this Application and Agreement, or the breach of this Application and Agreement, or the Cooperative’s Governing Documents, or the Cooperative’s Provision of a Cooperative Service, or the Consumer’s use of a Cooperative Service and if the dispute cannot be settled through negotiation, other than those claims/disputes expressly excluded in #16 below, then the Consumer agrees to first try in good faith to settle the dispute by mediation administered by the American Arbitration Association under its Commercial Mediation Procedures before resorting to arbitration.

15. ARBITRATION:

If Mediation (#14 above) is not successful or the claim/dispute is expressly excluded in #16 below, the Consumer agrees (a) to settle any controversy or claim arising out of, or relating to, this Application and Agreement, the Cooperative’s Governing Documents, the Cooperative’s Provision of a Cooperative Service, or the Member’s Use of a Cooperative Service by arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules; and (b) to file and prosecute any arbitration individually, and not as a representative party, member, or other participant in a class action or other representative proceeding; and (c) that judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction.

16. CLAIMS/DISPUTES EXCLUDED FROM MEDIATION AND ARBITRATION REQUIREMENT IN #14 & #15 ABOVE:

Disputes/claims involving the collection of funds and/or accounts receivable due to the Cooperative shall be exempt from the mediation and arbitration requirement and may be prosecuted in a court of competent jurisdiction in the State of Oklahoma.

17. ELECTRONIC SIGNATURES

Electronic signatures will be valid as original and multiple counterparts (paper and electronic) count as one.

I hereby verify I have acknowledged, understand and agree to the Terms of Agreement. I understand that by typing my full name and pressing the Submit button that I am consenting to the use of e-signatures and acknowledge it to be as legally valid as a paper/original signature, and this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.

Applicant Consent(Required)

I hereby verify the above 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 that I am consenting to the use of e-signatures and acknowledge it to be as legally valid as a paper/original signature, and this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.

People’s electric cooperative shall use its best efforts to furnish its members with adequate and dependable electric service, although it cannot and, therefore, does not guarantee a continuous and uniterrupted supply thereof. Upon signing, applicant and/or co-applicant confirms all information provided herein is truthful and accurate, and also agree to be bound by such rules, bylaws, terms and conditions of service, and regulations as may from time to time be adopted by the cooperative. This signed form will serve as a certificate of membership. By signing, the applicant and/or co-applicant authorizes the cooperative to seek past credit history and to release credit history for future inquiries.

Applicant & Co-Applicant Consent(Required)

We hereby verify the above information to be true and complete and agree to the terms and conditions. We understand that by typing our full names and pressing the Submit button that we are consenting to the use of e-signatures and acknowledge them to be as legally valid as paper/original signatures, and this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.

People’s electric cooperative shall use its best efforts to furnish its members with adequate and dependable electric service, although it cannot and, therefore, does not guarantee a continuous and uniterrupted supply thereof. Upon signing, applicant and/or co-applicant confirms all information provided herein is truthful and accurate, and also agree to be bound by such rules, bylaws, terms and conditions of service, and regulations as may from time to time be adopted by the cooperative. This signed form will serve as a certificate of membership. By signing, the applicant and/or co-applicant authorizes the cooperative to seek past credit history and to release credit history for future inquiries.

Account Number(Required)

Applicant Electronic Signature (Full Name)(Required)

Co-Applicant Electronic Signature (Full Name)(Required)