APPLICATION FOR MEMBERSHIP AND FOR ELECTRIC SERVICE
Please complete the below application to apply for electric Service with REA Energy Electric Cooperative Inc.  
  
REA Energy Electric Cooperative Inc., collects information required to effectively serve our members and does not share any Member information to 3rd party non-vendors.  Incomplete applications will not be processed.  Completed applications will not be processed until the following working day.  

If this is a Brand New Construction, you must contact REA Energy’s Engineering Department prior to starting the application process. Please call 724-349-4800 or 1-800-211-5667 Option 5.

If you have any questions, please contact our office at 1-800-211-5667 or 724-349-4800, Monday through Friday 7:00am -3:30pm.  

Today's Date:  
Date Service is Desired:  *  
Type of Request:  
Applicant First Name:   *
Applicant Last Name:   *
Applicant Middle Initial:  
Social Security Number:-  -   *
Drivers License Number:  *
License State:  
Birthdate:    
Employer:  
What type of home is this?
(House, Mobile home, Apartment/Condo, Camp, other)		  *
Is there Electric Service at the location?
(yes or no)		  *
Do you currently or have previously received service from REA Energy?
(yes or no)		  *
Is there an Outdoor Light that the Cooperative maintains?
(yes or no)		  *
Do you own the physical property the structure sits on?
(yes or no)		  *

*If you own the property, a signed deed is required.  If renting the property, a signed rental agreement is required.  In both cases, service will not be processed until the documentation is received.  Documentation can be faxed to 724-349-7151, emailed to memberservice@reaenergy.com  or dropped off at either the Indiana or Ebensburg office.

Billing Address:
Please enter address where bills should be sent.
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please enter address where service is requested.
Service Address:   *
Meter Number (if known):  
Please list any additional Meter Numbers and corresponding description here:  
E-mail:  *
Confirm E-mail:  *
Primary Phone:-  -    *
Cell Phone:-  -   
Business Phone:-  -     
Co Applicant Name: 
Co Applicant Social Security Number:-  -   
Co Applicant Driver's License Number:  
Co Applicant License State:  
Co Applicant Birthdate:    
Co Applicant Signature:
I have read and agree to the terms and conditions of REA Energy Electric Cooperative, Inc. I understand that by typing my name in the field provided is my electronic signature.		  
Fee & Deposit Information: (non-refundable unless otherwise noted)
Property Owners: 
Membership Fee:  $5.00
Administrative Fee: $20.00 per service if energized   $110.00 per service if de-energized
Online Sign up Fee: $7.50
Additional Fees may apply
*A signed copy of the deed for the property is required

Renters:
Membership Fee:  $5.00
Security Deposit:  $100.00 (refundable)
Administrative Fee: $20.00 per service if energized   $110.00 per service if de-energized 
Online Sign up Fee: $7.50
Additional Fees may apply
*A signed copy of the lease is required

For security purposes, once your Membership Application is received and reviewed, you will receive an email with an assigned member number.  At that point, any fees that are due will be available for you to review and pay.  All fees are due within 3 days of you receiving the email to prevent disconnection of the electric service.  

*For Residential accounts, documentation can be faxed to 724-349-7151, emailed to memberservice@reaenergy.com  or dropped off at either the Indiana or Ebensburg office.

Tax Information:
Residential Accounts:
Tax Questions:SALES TAX QUESTIONNAIRE
In the field area provided below, please indicate the one (1) statement that describes the type of occupancy at this address.
1.The service address is my personal residence (or vacation home) and I receive my bill through a Post Office Box or at another location. The electricity used at the service address is for members of my household and me solely for residential purposes.
2.The service address is residential rental property. The tenant pays and remits the utility bills to REA Energy Cooperative, Inc, directly.
3. The service address is residential rental property. The utilities are included in the rent and remitted by the landlord to REA Energy Cooperative, Inc, or the property is vacant.
4. The service address is for commercial or business purposes. My residential use portion is 90%. Send a properly completed PA Exemption Certificate,  Form Rev-1220 (if applicable).
5. The service address is occupied by someone other than me for whom I am currently paying the bill. The electricity usage is solely for residential purposes and applies to a parent/guardian relationship. Please check which applies or mark your comments in number "6" below.
a.The service address is the residence of a child under the age of 18 for whom I am a legal parent or guardian.
b.The service address is the residence of an individual for whom I am the court-appointed guardian. I have court papers that can support this relationship.
c. I do not live at this service address. I am paying the bills for the resident with their funds. The relationship is not a landlord/tenant relationship.
d. I do not live at this service address. I am paying the bills for the resident with my own funds and I am not the court appointed guardian.
6. Other: Please provide a detailed explanation or reason below.


Please indicate Tax Statement Number here:  *
If Tax Statement Number above is 6, please provide reason:  
What Fuel Source for heating is at the location?  *
What Fuel Source is used for the hot water tank at the location?  *
What Fuel Source does your stove use at the location?  *
What Fuel Source does your dryer use at the location?  *
 
Please read and agree to the terms and conditions of REA Energy.  Note: Agreeing to the terms and conditions is a requirement of the application process. All applicants are subject to a red flag check to verify information given. All future members applying for Membership via REA Energy’s website are subject to a Credit Identity Verification check.
I have read and agree to the terms and conditions of REA Energy Electric Cooperative, Inc. I understand that by checking the box and typing my name(s) in the field provided below is my electronic signature.
  Applicant Name and Co Applicant Name (if applicable):     *