Tri-County Electric Cooperative Loan Request

Applicant Information









Current Address Information




Former Address




Applicant Employer






Loan Information


I certify that all information on this form is complete and accurate and I authorize Tri-County Electric Cooperative to check with credit reporting agencies, credit references, and other sources disclosed herein in investigating the information given. I have read and understand the terms of this agreement. If the loan is turned over to an attorney for collection, I agree to pay reasonable attorney’s fees and court costs.