-APPLICATION FOR PERMANENT SERVICE AND/OR MEMBERSHIP-


Please complete the below application to apply for service.  A membership fee is required from all applicants.  Based on the results of a credit check, a deposit may also be required.  Once your account is created in our system, you will receive an email with the total amount due on your new account, including deposit amount (if applicable).  You will also receive a new member packet at the mailing address provided. Service cannot be connected on weekends or holidays.  If you have any questions regarding service, please feel free to contact our office during normal business hours 866-OUR-COOP (866-687-2667).

Note: All fields with the asterisk (*) are required.


Today's Date:  
Date Service is Desired:  *  
Type of Request:   *
First Name:   *
Last Name:   *
Middle Initial:  
SSN:-  -   *
D.L. No.:  *
License State:  
Birth Date:    
Employer:  
Prior Occupant:  

Mailing Address:
Please enter the address where bills should be sent.
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please enter the address where service is required.
Service Address:   *
Location: (Community or Subdivision)
*please provide Building Permit No., Lot No. or Mobile Home Permit No., if applicable:
 
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -   
Business Phone:-  -     
Spouse: 
Spouse SSN:-  -   
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  

My Energy Online Access:
If you would like access to your account online, please create a password below.  You can pay your bill, view your bills and manage your account with online access. For security purposes, please specify a password that has a combination of numeric and alpha characters.
Internet Password:  
Confirm Internet Password:  
Password Hint:

Previous or Existing Service:
Do you or have you had service with us previously?
    
Account Number:
Fee and Deposit Information:
A non-refundable application fee is required from all applicants.  Based on the results of a credit check, a deposit may also be required.  Once your account is created in our system, you will receive an email with the total amount due on your new account, including deposit amount (if applicable).

Membership Fee:  
Application Fee:  

Third Party Notification of Disconnection: (if applicable)
Name:
 
Home Phone:  
Business Phone:  
Street Address:  
City, State, Zip:  
If Renting, Landlord Name:  
Own or Rent:   *
Please select preferred billing method:   *
 
By checking this box, I acknowledge that I have read, understand and agree to the Service Rules and Regulations.

READ - MEMBERSHIP CONTRACT
1. Application and Connection Fees. The Applicant will pay to the Cooperative the sum of $25.00 which represents a nonrefundable application fee (connection fee).
2. Deposits. As a precondition to electric service being delivered to the Applicant’s premises, the Applicant agrees to pay a deposit as may be required by the Cooperative. Deposits are held as surety should an Applicant fail to settle his indebtedness with the Cooperative. Deposits are refunded, credited to the account, automatically after two (2) years of service if the member is in good standing (refer to the Service Rules and Regulations). Upon termination of membership, the membership fee and security deposit (if not already refunded) will be refunded or applied against any unpaid balance owed to the Cooperative.
3. Wiring Specifications. The Applicant will cause his premises to be wired in accordance with wiring specifications approved by the National Electric Code or applicable local code.
4. Compliance With By-laws. The Applicant will comply with and be bound by the provisions of the charter and by-laws of the Cooperative, and such rules, regulations, and rate schedules as may from time to time be adopted by the Cooperative. The Applicant agrees that part of the amount paid for electricity each year is for a subscription to Living in South Carolina Magazine.
5. Applicant Not Responsible for Cooperative Debt. The Applicant, by paying a membership fee and becoming a member, assumes no personal liability or responsibility for any debts or liabilities of the Cooperative and it is expressly understood that under the law the Applicant’s property is exempt from execution for any such debts or liabilities.
6. Subdivision Lighting. When the Applicant resides in a subdivision where the Cooperative furnishes public street lighting, the Applicant agrees to pay his pro-rata share of said street lighting based upon the number of residences and the number of street lights in the subdivision, or pursuant to any pre-existing homeowners' association agreement or covenant.
7. Operation Round Up. Members of the Cooperative participate in a charitable program named Operation Round Up, which rounds up the remaining cents on a member’s bill to an even dollar amount. These monies are distributed to charities in the Cooperative’s service area. The average annual cost per member is less than $6.00. Members who do not wish to participate in this charitable program may opt-out by contacting the Cooperative at (866) 687-2667.
8. Easements. If Applicant is owner of the property, the application shall be deemed to grant a 30 foot Right-of-Way Easement over said property as outlined in the  Cooperative’s standard Easement Form, which authorizes the Cooperative, among other things, to construct and erect electric lines and facilities, and to clear and maintain said Right-of-Way as to any trees, shrubs, or other obstacles. Additionally, if Applicant is owner of the property, the Applicant agrees to grant such easements as may be needed to serve other cooperative members. If Applicant is renting, it is agreed that they will cooperate with representatives of the Cooperative in securing the necessary easements. Authorized employees of the Cooperative shall have access to electric lines, meters and other facilities of the Cooperative as may be needed from time to time. That the Applicant agrees to keep any easement, whether the electric service is above ground or underground, clear of all obstructions, which may include a building, swimming pool, patio, driveway, deck or other improvement, and that the Applicant agrees to pay for removal of any obstruction or improvement which is in violation of the National Electric Code or applicable local code, or if the obstruction or improvement prevents access to any electric line or facility of the Cooperative. In lieu of paying for the removal of the obstruction or improvement, the Cooperative may in its discretion allow the Applicant to pay for the relocation of the electric line or facility of the Cooperative.
9. Pole Attachment and Apportionment. To reduce the number of poles used by the Cooperative and other utilities or entities, Applicant agrees to allow the Cooperative to attach its lines and facilities to existing poles of other utilities or entities, and to apportion the use of any line or facility. Applicant further agrees to allow other utilities or entities to attach their lines and facilities to poles owned by the Cooperative.
10. Limitation of Liability. Service to the Applicant when approved shall be at one of the nominal 60 Hz. voltages of the Cooperative as stated in the rate schedule. The Cooperative shall exercise all proper care in the construction and maintenance of the electrical distribution system but shall not be liable for damages resulting from upset to the system caused by civil disorders, strikes, nonavailability of materials, limited wholesale power supply, acts of God or other unusual circumstances.
11. Collection of Past Due Amounts. In the event of a default or failure to pay any outstanding indebtedness and after due notice of said default or failure to pay, Applicant agrees that if the Cooperative places the collection of said indebtedness in the hands of an attorney, or any portion thereof, or any legal services are performed in connection therewith a reasonable attorney’s fee and all costs, including court costs incurred, will be added to the debt and will be collectible as a part thereof: furthermore, any past due debt shall bear interest at the legal rate until collected and paid in full. All past due debts are established by Cooperative policy.
12. Meter Tampering. Applicant acknowledges that he is aware that under the Code of Laws of South Carolina, it is a crime for any person to alter, tamper with or bypass a meter which has been installed for the purpose of measuring the use of electricity. Applicant further understands that he is responsible for all penalties imposed by Cooperative policy and/or will be subject to prosecution if the meter in his name is found in a condition which would cause electricity to be diverted from the recording apparatus of the meter or causes the meter to inaccurately measure, or that there is evidence that same has taken place in the past, notwithstanding that Applicant may not have caused the diversion or inaccurate measurement.
13. Termination Policy. Should the Applicant fail to pay for services rendered by the Cooperative, or fail to comply with any State or local law or regulation, or any Cooperative by-law provision, service will be terminated. The Cooperative will not terminate the electric service of any member during extreme hot or cold temperatures, as provided for by the Cooperative’s procedures for termination of service.
14. Termination Policy of Service to Members With Special Needs. If the Applicant, or household member of the Applicant, has special medical needs, which have been certified by a licensed health care provider, special efforts will be made by the Cooperative to notify the Applicant of any termination of service, and to permit the Applicant in certain cases to enter into delayed payment plan for electric service. Termination of electric service to an Applicant, or household member of the Applicant, with special medical needs will only be on a day when the Cooperative’s business office is open (and when the Cooperative’s business office is open the next day), and such termination of electric service will only be between the hours of 8:00 a.m. and 3:00 p.m. For more information, ask about the Cooperative’s policy and procedures for termination of electric service to members with special needs.
15. Third Party Notification of Termination. The Cooperative permits Applicant to name a third party who will receive an additional notice of any disconnection notice sent to the Applicant. Such additional notice to a third party does not obligate the third party to pay for the services rendered to the Applicant, nor will it necessarily defer or prevent a disconnection if payment is not received by the Cooperative. Applicant is not required to name a third party. If Applicant desires to name a third party to be notified of any disconnection, please provide name of third party.
By checking this box and typing my name in the field area provided below, the Applicant hereby applies for membership in, and agrees to purchase electric energy from Broad River Electric Cooperative, Inc. (the Cooperative) upon the above terms and conditions. 

The Applicant understands this is my electronic signature.

  Applicant Name:     *