An individual who requests a joint membership with Golden Valley Electric Association (GVEA) may do so by having both parties complete this form. Upon acceptance by the Association, the membership shall be deemed a joint membership. A joint membership allows either party to conduct business on behalf of the membership. This form should only be completed if you are already a member with an active account. Provide a phone password or PIN to be used for identification verification in lieu of a Social Security Number or Document Locator Number (optional)(PIN must be between 4 to 6 numbers in length) 申请人名字(必需) 第一个 最后的 Social Security Number Driver's License Number Driver's License 状态 Date of Birth (mm/dd/yyyy)(必需) 月 一天 一年 电子邮件(必需) 主要电话(必需)备用电话配偶/ Co-applicant配偶 or Co-applicant(必需) 配偶 Co-applicant 名字(必需) 第一个 最后的 Social Security Number Driver's License Number/状态 Date of Birth (mm/dd/yyyy)(必需) 月 一天 一年 电子邮件(必需) 主要电话(必需)备用电话I am consenting to receive information relating to my account(s) and/or other GVEA business via automated calls, texts or email on any number (or any future telephone numbers) which I may provide to GVEA. I understand that I am responsible for notifying GVEA of any changes to my personal contact information. mg冰球突破豪华版下载地址(必需)Click the (+) to add another address. 添加 删除所有权你是:(必需) 老板 其他 In process of purchasing?(必需) 是的 No 主人的名字(必需) 老板's Contact Information(必需) 第三方 Notification You may designate a third party to receive a copy of any termination notice regarding disconnections initiated by GVEA. Some of the information this notice will contain includes the name and address of the member whose service is to be disconnected, mg冰球突破豪华版下载地址, the date of disconnection, and explanation of the reason for the proposed disconnection, 在适当的时候, a statement of the amount of the delinquent bill. This designation does not entitle the party named to act on behalf of the member.第三方?(必需) 是的 No 名字(必需) 第一个 最后的 电话(必需)电子邮件(必需) 邮寄地址(必需) 街道地址 地址线2 城市 状态 阿拉巴马州阿拉斯加美属萨摩亚亚利桑那州阿肯色州加州科罗拉多州康涅狄格特拉华州哥伦比亚特区佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰麻萨诸塞州密歇根明尼苏达州密西西比州密苏里州蒙大拿内布拉斯加州内华达新汉普郡新泽西新墨西哥纽约北卡罗莱纳北达科他Northern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州宾西法尼亚波多黎各罗德岛州南卡罗来纳南达科塔州田纳西州德州犹他州U.S. 属维尔京群岛佛蒙特州维吉尼亚州华盛顿西维吉尼亚州威斯康辛州怀俄明美洲武装部队欧洲武装力量太平洋武装部队 邮政编码 同意(必需)Members may be required to pay fees upon application. The Association also requires a separate deposit for each meter, unless an individual can provide a letter from the utility which last provided comparable service, stating that within the last 12 months of continuous service, the applicant has not been past due in payment more than twice, has not been delinquent in payment in the last 6 months, and the service must have been provided within the last two years. A deposit may be waived upon application of service for returning member upon satisfaction of these same criteria from the Association’s records.In connection with signing this application I/we give GVEA permission to run an Equifax 能源 Risk Assessment, to determine if a security deposit is required and for identification purposes. *If a social security number is not provided, further identification will be required.I understand that a misstatement in this application may result in GVEA refusing to provide service, 断开mg冰球突破豪华版下载, cancelling any membership or all of these results. I certify that all the information given above is true and correct to the best of my knowledge. By accepting service from GVEA, the applicant(s) agree to comply with Golden Valley Electric Association Bylaws, Articles of Incorporation, 政策, Operating Tariff and regulations adopted by the Directors. 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.If anyone at this location is using a life support system, please contact our credit office at (907) 452-1151.Membership Holder Electronic Signature (Full 名字)(必需) 配偶/ Co-applicant Electronic Signature (Full 名字)(必需) Our team will review this information and respond with any questions within 2-4 business days. If your request is urgent please contact one of our representatives at (907) 452-1151 during our normal business hours of Monday-Friday, 8:30AM – 4:30PM, except holidays.评论This field is for validation purposes and should be left unchanged.