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PRESS HARD: 4 COPIES INTERMOUNTAIN RURAL ELECTRIC ASSOCIATION 5096 North U.S. Highway 66, P.O. Drawer A Sedalia. X66--~ 06 01 3 5-0220 I I f I I I I I L Account No. L_l-W LLLJ Work Order No. Name Location No. MEMBERSHIP APPLICATION AND ELECTRICAL SERVICE AGREEMENT The undersignetl. hereinafter called the "Applicant," hereby applies far membership in, and agrees to purchase electric energy Irom Intermountain Rural Electric Assocation, hereinafter called the "Association," upon the following terms and contlnions: 1. The Applicant will pay to the Association the sum of $5.00: upon execution antl tiling this applrcalion and when membership is acceptetl by the Assocralion, the sum paid will constitute the Applicant's membership or connection lee. 2. The Applicant will. when electric energy becomes available, purchase Irom the AaaOCallon all electric energy used on the premises described below and will pay Therefore monthly al rates to be determinetl from time-to-lime in accordance with the bylaws of the Association, Dursuanl to the Association's rules antl regulations, provided, however, that the Association may limit the amount of electric energy which it shall furnish to the Applicant. The Applicant will pay a minimum bill of $ per month for services an4 facilities. or as may hereinafter be modified by the Association's rules antl regulations. 3 The Applicam untlerstantls the meaning of "when service becomes available" to constitute the inslanalion of primary service on or adjacent to the Applicant's propeny. and when so installetl, billing will commence whether or not the premises are reatly for connection. The APPlicant will cause his premises to be wired in accordance wnh wring specifications approvetl by the Association, and will be ready for connection when service is made available by the Association. 4. The Applicant agrees that the sale of the below~descnbed propeny to which electnc serwce wiU be mane available snot/ in no way release the Applrcanl of his obligation untler This agreement. It shall be the sole obligation of the Applicant to secure from the purchaser an assignment of all rights antl obligation under this agreement antl effect memhershp and service 5. The Applicant will comply with and be bound by the provisions of the articles of incorporation, the bylaws and rules and reg ulalions of the Assocralion, as now constil uteri and as may Irom time~to time be motlilied or amentletl. 6. The Applrcanl for himself/herself, for his/her heirs or assigns, assumes responsibiluy for payment of minimum bill and/or eleclrrc serwce bills incurred. 7. The Applrcanl underslantls, shoultl it become necessary for the Association to institute legal action to elfecl collection of amount due under this agreement, the Applicant agrees to pay all court casts and attorney's lees incurred by the Association as a resWl of Applicant's failure to make the payment of minimum bill and/or electric service bills incurred as required herein. 8 The Applicant, by paying a membership lee and becoming a member, assumes no liabdny or responsibilities for any debts or liabilities of the Assocralion, and rl is expressly understood that under the law his/her private properly is exempt from execution for any such tlebts or liabilities. 9. The Applicant hereby grants to the Association, with no charge, the necessary easements and rights ol~way over. under and across the property of the Applicant for improvements including but not limned to poles, condunors, undergrountl tac~hbes antl metering apparatus hereon and ingress antl egress to the Association's lacihbes hereon far the purpose ol, but not limitetl to, maintenance. operation and meter reading. The acceptance of the application by the Association shall constiwle an agreement between the Applrcanl and the Association, and the contract for electnc service shall continue m force for ten years Irom the tlale serwce is made available by the Association to ire Appl¢ant, and thereafter until cancelled by at leas) thirty (30) days written notice given by either parry to the other. II for any reason the Association is unable to furnish service to the Applrcanl. the sum of $5.00 will he returned to the Applicant. Date 19 Signature: District Wdness Applicant hereby acknowletlges receipt of completed copy o this Agreement. So. Sec. p a 0 U V N c c o w ~ 'm O ~ Owner Code Cotle ^ Charges $5 00 M or C nmer $Ireellight Charge Rebate No A A C Legal Description of Property: Section _ 7 S R W County of Previous Name ~ A/C p 0 - Mtr. p m Fieltl Check Letter 0 c°v O Ves _ No q IREA Forma RevSetl 6/6] ~ ~ ~ ~ ~ ~ Last Name Fusl Mitltlle Address t l I I I I I I I I I I I I I I I 1 1 1 1 1 Address 2 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ City/Slate ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Zip Code ~ ~ ~ ~ ~ ~ L~J Telephone No.: Home Work . Sre Servme: Amps/HP ~ Residential Heating Requuemenls Sq Feet of Home Radiant Baseboard Other (type) - Hot Water Heater: Electric - Translarmer No. Critical Serve 8 Type Credif Name 8 No. W!O Name 8 No. ORIGINAL -PH Commercial Heat Pump Solar _ Elec Furnace Elec. Boiler Other (type) 8 8 Amt. Aml. Book V/N Dale Req.