ELECTRIC SERVICE AND CO-OP MEMBERSHIP APPLICATION

PO Box 40, Oakdale, WI 54649 | 800-241-2468 | Fax 608-372-5173 | www.oakdalerec.com

OEC Use Only	Location:	Account:	Customer:

APPLICANT
NAME (First, MI, Last):	SOCIAL SECURITY #:
MAIDEN NAME:	DATE OF BIRTH:
HOME PHONE #:	CELL #:	WORK #:
EMAIL ADDRESS:
EMPLOYER:
SERVICE ADDRESS:
BILLING ADDRESS: (IF DIFFERENT FROM SERVICE ADDRESS)
OWN	RENT	IF RENT, PROPERTY OWNER:
TYPE OF SERVICE: (SELECT ONE BELOW)
PRIMARY RESIDENCE	DAIRY FARM	COMMERCIAL	PUBLIC BUILDING
SEASONAL	FARM-OTHER	IRRIGATION	OTHER
CO-APPLICANT
NAME (First, MI, Last):	SOCIAL SECURITY #:
MAIDEN NAME:	DATE OF BIRTH:
HOME PHONE #:	CELL #:	WORK #:
EMPLOYER:
COMMERCIAL SERVICE ONLY
BUSINESS NAME:
TAX EXEMPT:	NO	YES	IF YES, PLEASE PROVIDE FORM
TYPE OF BUSINESS: (SELECT ONE BELOW)
LIMITED LIABILITY	INCORPORATED	SOLE PROPRIETORSHIP	PARTNERSHIP
ADDRESS:	STATE OF INCORPORATION/ORGANIZATION:
FEDERAL ID/SOCIAL SECURITY:
CONTACT PERSON:	CELL #:	WORK #:
EMAIL ADDRESS:
ADDITIONAL CONTACT:	CELL #:	WORK #:
EMAIL ADDRESS:
OPERATION ROUND UP
As a member of OEC, I can enroll in the Operation Round Up program and my energy bill will be rounded up to the next highest dollar each month. The extra charge will benefit needy charities and community service organizations within Oakdale Electric Cooperative’s service territory in accordance with the guidelines set forth by the Board of Directors. I understand that the average yearly cost for participation is about $6.
Yes! I want to contribute to Operation Round Up.

By signing below, you are applying for and agree to become a member of Oakdale Electric Cooperative and to accept all terms and conditions of membership as provided in the "Membership Agreement Terms and Conditions.” This agreement for electric service shall remain in force until cancelled by withdrawal of the Applicant from membership in the Cooperative.

Applicant: ___________________________________________________________________________________________________

SIGNATURE	DATE

Co-Applicant: ________________________________________________________________________________________________

SIGNATURE	DATE