Primary Account HolderName(Required) First Last Primary Account Holder Social Security Number(Required)Your SSN will remain secure and is used for identity protection and a credit check. By signing this form you are authorizing YVEA to run a soft credit check to determine if you will be required to pay a deposit. If a deposit is required you will be contacted by a Member Service Representative. Primary Account Holder Email(Required) Birthdate (Must be 18)(Required) MM slash DD slash YYYY Cell Phone(Required)Alternate PhoneService 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 Condo/Townhome/Apt. Name Click the appropriate title(Required) Owner Renter Is this a 30 day or less rental unit?(Required) Yes No Is your mailing address different than your service address?(Required)*All voting material for annual elections will be sent by mail to the address on file. Yes No 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 Would you like to add a spouse to your account?(Required)Adding your spouse, or another individual, as a secondary account holder allows either person to be authorized to request information or make any changes on your account. Yes No Spouse InformationName(Required) First Last Spouse Social Security Number(Required)Your SSN will remain secure and is used for identity protection and a credit check. By signing this form you are authorizing YVEA to run a soft credit check to determine if you will be required to pay a deposit. If a deposit is required you will be contacted by a Member Service Representative.Spouse Email(Required) Spouse Cell Number(Required)Effective date of service(Required)Service connections are done Monday through Friday. Our teams strives to process all service requests within 3 business days. MM slash DD slash YYYY 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 Bank InformationAccount Type Checking Savings Bank Name(Required) Bank Routing Number(Required)Bank Routing Number (Confirm)(Required)Bank Account Number(Required)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)Are you disconnecting your service at your current location?(Required) Yes No Disconnecting Service 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 Account Number(Required)Condo/Townhome/Apt Name Landlord/Property Mgr/Owner/Realtor/Buyer Name Effective date of disconnect(Required)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. MM slash DD slash YYYY Landlord/Property Manager/Owner/Realtor/Buyer Phone NumberDoes the location currently have solar?(Required) Yes No If yes, please review the following Achnowledgement:(Required)o Member acknowledges that by approving the installation of the proposed system, YVEA does not guarantee or warrant production equal to the installed capacity of the generator, the success of the generator, or the overall performance of the system. YVEA is only responsible for approving interconnection of the generator to YVEA’s system in a manner that is consistent with YVEA’s rules and regulations. o YVEA’s current general services rates are broken into two segments, the energy rate and the System Access Cost. The energy rate covers energy received from YVEA in the form of kWh. The System Access Cost is a flat monthly charge that covers poles, wires, staffing and other system related items that are still needed by net metered services, and therefor is not a charge that will be offset by generator production. I hereby acknowledge that YVEA’s energy rate and system access cost could change in the future. Go to https://www.yvea.com/yvea-rates-colorado-and-wyoming for additional rate schedule information. o Member Acknowledges that if this generation system causes the power quality to fall outside of YVEA parameters, YVEA has the right to disconnect my electrical service. YVEA staff will reach out to you prior to the disconnect. o Please review the Net Meter Policy https://www.yvea.com/wp-content/uploads/YVEA_NetMetering_REV04.1_Final.pdf and the Interconnection Policy https://www.yvea.com/wp-content/uploads/YVEA-Interconnection-Policy-V2.4-1.pdf for all rules and regulations. o Member acknowledges that this is the Interconnection Agreement, and YVEA considers the Interconnection Agreement complete with the signature below. I hereby certify that, to the best of my knowledge, the information provided in this Application is true. I have read and agree to abide by YVEA’s Interconnection Policy, this, if this generation system cause the power quality to fall outside of YVEA parameters, YVEA has the right to disconnect my electrical service. I will provide YVEA with the Certificate of Completion when the generator has been installed. YVEA has the right to enforce curtailment for reliability, economic, safety or any other reason deemed appropriate for system operation reasons.CommentsOperation 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. I agree to the terms of service.(Required)Signature (Full Name) PhonePhoneThis field is for validation purposes and should be left unchanged.