Download our Membership Application (PDF). Please be sure to include a copy of your Driver's License when returning your Application, and email to UEC. Or fill out our online Membership Application Form.Application Type(Required) Individual/Joint Organization Name(Required) First Last Organization Name(Required) Authorized VotersClick the + button to add another line Add RemoveHome PhoneCell PhoneEmail(Required) Fax Social Security Number / EIN Number(Required) Service Address(Required) Street Address Address Line 2 City State 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 Code Mailing Address(Required) Street Address Address Line 2 City State 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 Code Copy of Driver's License(Required)Max. file size: 300 MB.Please select:(Required)If Corporation, Partnership, or Other, specify voting member(s) on Voter Registration Form. Individual/Joint Individuals Corporation Partnership Other Specify(Required) Joint Membership?(Required) Yes No Name(Required) First Last Home PhoneCell PhoneEmail(Required) Fax Social Security Number / EIN Number(Required) Member Consent(Required) 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.The undersigned does hereby make application for membership in United Electric Co-op, Inc. The undersigned agrees to abide by the By-Laws, the Service Requirements, and Customer Service Rules of United Electric Co-op, Inc. The undersigned also requests electric service and agrees to pay the charges therefore as fixed by the Board of Directors and all costs of collections including attorney fees. The undersigned further agrees and consents to allow United Electric to contact Applicant for all business and emergency purposes (such as annual meeting notification, emergency, and planned electrical outages) as well as all collection purposes, which may include but not be limited to contact by automated calls (including calls to wireless numbers), text messaging, email, or fax, at the numbers designated above. Under penalties of perjury, the undersigned certifies that the number shown on this form is the correct taxpayer identification number. The undersigned agrees that the information provided on this form and other related documents may be stored electronically, at which time the paper form of this agreement may be destroyed. Both the member and United Electric Co-op, Inc. agree that any hard copy printout of this electronically stored information will be deemed to be as authentic and valid as the original document.Member Electronic Signature (Full Name)(Required) Voter Authorization FormLegal Business Name(Required) Authorized Voters(Required)(Click the + button to add a new row) Add RemoveTitle(Required) This authorization will remain in effect until revoked or changed in writing and delivered to United Electric Co-op, Inc. The first authorized voter to register at a meeting will be the authorized voter for that meeting. If more than one person is authorized to vote, the person registering for the meeting will be the authorized person to vote for the member at the meeting. In case of absentee voting, the receipt of the ballot by United Electric Co-op, Inc. will be prima facie evidence that it was cast by an authorized person on behalf of the member. EmailThis field is for validation purposes and should be left unchanged.
