Application for Membership Membership/Security Deposit Certificate Easement

Record Type Name

Applicant Information

Applying as:

Single ApplicantJoint ApplicantBusiness

Business Name

Federal ID

First Name

Last Name

Phone

Date of Birth

Social Security Number

Employer

Are you married?

YesNo

Spouse's First Name

Spouse's Last Name

Spouse's Date of Birth

Spouse's Social Security Number

Requested Service Transfer Date

Joint Applicant Information

Important: Joint memberships are available only to married couples. Both applicants must submit a copy of their driver's license and complete the electronic signature process. After this application is submitted, your spouse will receive a separate email with a link to complete and sign their portion of the application.

First Name

Last Name

Phone

Service Address Information

Street

City

State Abbreviation

Zip Code

Is mailing address different than service address?

Mailing Address

Street

City

State Abbreviation

Zip Code

Required Uploads

Driver's License

Letter of Authorization

Copy of W-9 (if needed)

Terms and Conditions

(1) I apply for membership in Kenergy Corp.(hereinafter referred to as “cooperative”) and agree to pay the membership fee of FIVE DOLLARS ($5.00).
(2) I agree that as a member of the cooperative:
(a) I will pay the cooperative’s tariff rates as approved from time to time for all electric energy charged to my account.
(b) I grant the cooperative the permanent right to construct, operate, remove, replace and perpetually maintain its electric power lines (whether overhead or underground) and all associated equipment (including fiber optic cables) on the property owned or occupied by me, and in or upon all roads, streets or highways abutting that property, and will execute and deliver to the cooperative any conveyance, grant or instrument which the cooperative shall request for said purpose or any of them. I agree that all wires, meters, poles, transformers and other equipment which the cooperative constructs or installs on that property will, at all times, be owned by the cooperative, and the cooperative shall have the right to come on that land to exercise the rights granted it by me herein, which include the right to cut, trim and control the growth of trees, shrubbery and other vegetation, by any reasonable means, that may interfere with or threaten to endanger the operation or maintenance of lines or other equipment.
(c) I understand that as a member of the cooperative I will have the rights and privileges of a member under the Articles of Consolidation and Bylaws of the cooperative and will be bound by the responsibilities, rules and regulations imposed on a member by those documents and any amendments to those documents that may from time to time be adopted by the Board of Directors or membership of the cooperative.
(3) I further understand that acceptance of my application for membership by the Board of Directors of the cooperative will constitute an agreement between the cooperative and me upon the terms set forth herein.
(4) Applicant agrees that this membership shall be:

a) Individual Membershipb) Joint Membership (both parties must sign certificate)c) Business, Church or Organization

(5) The undersigned Member(s) agrees to deposit with the cooperative such security deposit as is required by the rules and regulations of the cooperative and hereby grants cooperative a security interest in that deposit as collateral for service to be supplied by cooperative. If service to Member is terminated, cooperative shall apply that deposit and any assigned assets held by the cooperative to any bills due the cooperative and any portion of said deposit not so applied shall be refunded to undersigned upon termination of service.

Accept Terms and Conditions