Step 1 of 3 0% Member InformationName(Required) First Last Account Number(Required) Phone(Required)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 Please Select(Required) Trade a Tree Removal Trade a Tree Rebate Form Both Tree RemovalTree Variety and Location(Required)Property Owner(Required) Rebate FormTree Variety(Required) Quantity Purchased(Required)Cost Per Tree(Required)Total Cost(Required)Type of Refund(Required) Mail Check Credit Account Member Agreement & ConsentMember 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.I request that the following tree(s) be removed from in or near the primary lines on my property. I understand that all wood larger than 4 inches in diameter will be left on the property and smaller branches will be chipped and removed. The stumps of deciduous trees will be treated with an approved herbicide.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.I request that the following tree(s) be removed from in or near the primary lines on my property. I understand that all wood larger than 4 inches in diameter will be left on the property and smaller branches will be chipped and removed. The stumps of deciduous trees will be treated with an approved herbicide. I certify that the tree(s) was purchased for planting at the above address and is in United Electric Co-Op, Inc.'s service territory. I will allow a representative of United Electric Co-op, Inc. to verify installation of the tree(s).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.I certify that the tree(s) was purchased for planting at the above address and is in United Electric Co-Op, Inc.'s service territory. I will allow a representative of United Electric Co-op, Inc. to verify installation of the tree(s).Member Electronic Signature (Full Name)(Required) NameThis field is for validation purposes and should be left unchanged.
