Military Personnel Protection Application

MVEC complies with the Federal Trade Commission’s Red Flag rule, which helps detect, prevent and mitigate damage caused by identity theft. MVEC reserves the right to ask questions to help validate the identity of an account holder when changes to an account are requested by phone or in person.

Contact Information

Relationship to military person

SelfSpouseOther

Account Number

First Name

Last Name

Primary Phone

Work Phone

Email Address

Confirm Email Address

Address

Address Line 1

Address Line 2

City

State

Zip Code

Account Information

Total annual household income

Number of persons in household (including yourself)

Caseworker

Caseworker Name

Caseworker Phone Number

Uploads

Scan or photograph supporting documentation and upload here

An application mailed without copies of your income information and proof of qualifying military duty will be incomplete, and you may not receive protection from shut-off. If you have received Energy Assistance within the past 12 months, you may be eligible for Military Service Personnel protection.

Do any of the following exist in your home?

Medical Emergency Disabled person in residenceMedically-necessary equipmentI have already been approved for fuel assistance or emergency assistance from a local energy assistance agency based on my income.

This is a declaration of my inability to pay for heat during cold weather months. I’m willing to make payment arrangements, approved by MVEC. By signing this form, I hereby authorize any gas or electric utility that serves us to exchange billing information. I attest the above information is true and correct, and agree to abide by the terms of the payment arrangement.

I can pay (fill in amount) $

Frequency

WeeklySemi-monthlyMonthlyOther

This information is true and correct. I give permission to any energy provider or public assistance agency that serves me to exchange billing information with other energy providers.

I acknowledge

Signature (type your full name)

Date

To ensure an actual person is filling out the form, please answer the following question: 6 + 2 =

If you do not wish to submit this form online or are unable to attach your supporting income documentation, you can print and mail or fax this application to: Minnesota Valley Electric Cooperative ATTN: Collections 125 Minnesota Valley Electric Drive | Jordan, MN 55352 Fax: 952.492.8281 Email: info@mvec.net

Contact Information