Service Connect Application

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For electrical service, BVEA will need the following application completed and signed. There is a $40.00 connect fee, and we may require a $150.00 deposit for residential service.

In lieu of a deposit, you may have your previous utility company fax over a letter of credit with no negative reporting in the past 12 months to 307-368-0931, your deposit will be waived.

If you have had service with us previously, a business account, or are moving a service, an application is still required.

BRIDGER VALLEY ELECTRIC ASSOCIATION, INC. MEMBER/SERVICE CONNECT APPLICATION

First and Last Name

Phone Number

Last 4 of SSN

Date of Birth

Service Location Address

City

State

Zip

Billing Address (if different)

City

State

Zip

Previous Address

Previous Address City

Previous Address State

Previous Address Zip

Employer

Account Type *

Individual Account Joint Account

Spouse/Roommate Name

Spouses Maiden Name

Phone

Date of Birth

It is agreed that all bills will be paid when due. Failure to do so will result in disconnection of service I agree to pay a reasonable attorney’s fee and other costs of collection after default and referral to any attorney I certify that the information I have provided is true and accurate and any false statement made constitutes reason for immediate disconnection I consent to a soft credit check for the purpose of a deposit for service

Employer

Phone

Home Owner Status

Status

Owner Renter

Landlord

Phone

Closest Relative Not in Household

Name

Phone

Address

City

State

Zip

Date of Application

Date of Requested Service Transfer

Additional Information

Do you want to participate in Operation Roundup?

Yes No

This program rounds up to the nearest dollar. Average is $6.00 per year and helps people in the BVEA service area.

Interruption and Liability of Electric Service

It is agreed that all bills will be paid when due. Failure to do so will result in disconnection of service
I agree to pay a reasonable attorney’s fee and other costs of collection after default and referral to any attorney
I certify that the information I have provided is true and accurate and any false statement made constitutes reason for immediate disconnection
I consent to a soft credit check for the purpose of a deposit for service

I hereby request electric service from Bridger Valley Electric Association, Inc., and herewith make application for membership in said Association. I agree to purchase electric energy from the Association. I agree to be bound by the Articles of Incorporation, the By-Laws and amendments thereto, and such Rules and Regulations as may be adopted from time to time by the Board of Directors.

I understand that if I am required to give a deposit for service, that it will be held for the following.

Consumer, 1 Year. Business, 2 Years.

Deposits will be returned as a credit to the account, with interest, if all payments are made on time during the allotted time frame, or the account is no longer active for the consumer or business.

Applicant Consent

Application consent- by checking ypu are agree with term and condition of this E Statement Agreement

Co-Applicant/ Roommate Consent

Co-Applicant/ Roommate Consent - by checking ypu are agree with term and condition of this E Statement Agreement