A W9 is required for all Commercial Services Name(Required) First Last Email(Required) Phone(Required)Organization Name(Required)Organizations must provide a W9 form. Find a W9 form visit IRS website.Address of Service Location(Required) Address Address 2 City/Town State/Province 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/Postal Code Is your mailing address different than your service address?(Required) Yes No Business Mailing Address(Required) Address Address 2 City/Town State / Province 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 / Postal Code Is this a 30 day or less rental (short term rental) unit? Yes No Service Effective Date (mm/dd/yyyy)Service connections are done Monday through Friday. For same day service YVEA must receive form before 3:30 p.m. MST, or after hours fees will apply. Month Day Year How would you like to receive your account information?(Required)*All voting material for annual elections will be sent by mail to the address on file. Mail Phone Would you like to sign up for AutoPay via bank draft?(Required)*Member may also go paperless and pay bill with a credit card with our SmartHub app. Yes No Business Bank InformationBusiness Account Type(Required) Checking Savings Business Bank Name(Required) Business Bank Routing Number(Required)Business Bank Routing Number (Confirm)(Required)Business Bank Account Number(Required)Business Bank Account Number (Confirm)(Required)Consent(Required)I authorize Yampa Valley Electric Association (YVEA) to process entries to my financial account in the amount of my current monthly electric billing obligation. This authority will remain in effect until written notice is given by either party to terminate the authorization. Notification of cancellation shall be effective upon receipt of the written notice. I agree that YVEA is authorized to delete and change information regarding my financial institution after verification of my personal information. Should an erroneous debit be made to my account, I authorize YVEA and my financial institution to stop payment, reverse the entry, or make any adjustment necessary to my account to correct the erroneous entry. A written notice explaining the changes will be sent to me by YVEA. I understand that YVEA may assess a fee of $35 if my financial institution dishonors the electronic transaction. I agree to the terms of service.(Required)CommentsPlease upload your W9 Form(Required)Accepted file types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip, Max. file size: 10 MB.Operation Round Up Program(Required)Agree to participate in YVEA's Round-Up Program so that each monthly bill will be rounded up to the next dollar and the accumulated round-up funds will be given to YVEA's Caring Consumers Foundation dba/Operation RoundUp for distribution for charitable purposes. The average cost per year is $6. Operation Round Up Page -Select-Agree to Round UpDisagree to Round UpConsent(Required)The Applicant agrees to be responsible for the electric charges at the location designated above until such time that the Applicant requests and receives discontinuance of service. It is agreed that all bills will be paid by the appropriate due date and failure to do so may result in discontinuance of service. This Application for Electric Service shall constitute a service contract between the Applicant and the Association, a grant of security interests in applicant's future capital credits, and the Applicant agrees to be bound by the Bylaws, Rules and Regulations of the Association. The applicant agrees that any information contained in this request may be used to collect on a delinquent account. The Applicant also agrees to pay late fees (penalty interest) of 1.5% per month on all delinquent charges until paid in full, and agrees to promptly reimburse the Association for all collection costs and attorney's fees incurred by the Association to collect delinquent amounts owed on Applicant's account after default. Agree to the terms of service.(Required)Signature (Full Name) CommentsThis field is for validation purposes and should be left unchanged.