New Member Form

GVEA is a member-owned electric cooperative. When you accept service from GVEA, you agree to comply with Golden Valley Electric Association Bylaws, Policies and Operating Tariff. Copies of these documents are available upon request.

Have you ever been a member of GVEA before?(Required)

是的

Under what name?(Required)

Address of previous GVEA location(Required)

Street Address Address Line 2 城市状态 ZIP Code

Primary Member Information

名字。(Required)

第一个 Middle Initial 最后的。

Mailing Address(Required)

Street Address Address Line 2 城市状态 ZIP Code

电话(Required)

电子邮件(Required)

SSN (used for credit verification and GVEA capital credit purposes)(Required)

Date of Birth (mm/dd/yyyy)(Required)

Driver's License Number/状态(Required)

Do you have a joint applicant?(Required)

是的

Joint Member Information (Spouse/Co-Applicant)

(If joint, GVEA may collect the full amount owed from either of the applicants.)

名字。(Required)

第一个 Middle Initial 最后的。

Mailing Address(Required)

Street Address Address Line 2 城市状态 ZIP Code

电话(Required)

电子邮件(Required)

SSN (used for credit verification and GVEA capital credit purposes)(Required)

Date of Birth (mm/dd/yyyy)(Required)

Driver's License Number/状态(Required)

Rental Property or Business?

Is this a rental property or Business?(Required)

是的

Are you the:(Required)

If this is a business, please describe:

老板/代理名字。(Required)

第一个最后的。

老板/代理电话(Required)

老板/代理 Address(Required)

Street Address Address Line 2 城市状态 ZIP Code

Third Party 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, the service address, the date of disconnection, and explanation of the reason for the proposed disconnections, and where appropriate, a statement of the amount of the delinquent bill. This designation does not entitle the party named to act on behalf of the member.

名字。

第一个 Middle Initial 最后的。

Address

Street Address Address Line 2 城市状态 ZIP Code

电话

Agreement & Consent

Member Electronic Signature (Full 名字。)(Required)

Joint Member Electronic Signature (Full 名字。)(Required)

电话

This field is for validation purposes and should be left unchanged.

Board of Director Application Deadline Approaching

Primary Member Information

Joint Member Information (Spouse/Co-Applicant)

Rental Property or Business?

Third Party Notification

Agreement & Consent