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Membership Application Information Applicant's Name Application Date Connect Date 911 Address (Physical Service Address) 911 Address (Physical Service Address) Address 2 City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Mailing Address If Different Than Physical Address Mailing Address If Different Than Physical Address City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Primary Phone Cell Phone Business Phone Other Contact Social Security or Tax ID # Driver License # Copy of Driver License One file only.100 MB limit.Allowed types: gif, jpg, png, svg. Applicant's Email Date of Birth Rent or Own Location Own Rent I agree to the Terms of Service. Membership & Service Application & Agreement for Electric Service The undersigned "Applicant" hereby applies for membership in, and electric service from the Cooperative upon the following terms and conditions: The undersigned applicant-member agrees to purchase all central station electric service and energy used on the premises described below from the Cooperative; and warrants that the premises, together with the structures and facilities located thereon, are safely wired in accordance with the requirements of the most recent issue of the National Electric Safety Code. The applicant-member agrees to comply with and be bound by the provisions of the charter and bylaws of the Cooperative and the rules and regulations of the Cooperative as established by its Board of Directors. The applicant-member understands and agrees that the Cooperative shall not be liable for service interruptions caused by acts of nature, accidents, service repair, lawful governmental or regulatory order and other causes beyond the control of the Cooperative. The applicant-member agrees to provide an easement for the facilities of the Cooperative and/or access to the property. Any member found to have an unsealed meter base showing no signs of tampering may have a $50 fee applied for the first offense and a $100 fee applied for each subsequent offense. If signs of tampering are present, a $500 fee will be applied for the first offense and a $1,000 fee will be applied for each subsequent offense. Per the HOTEC Bylaws Sec. 7.4g, the member voluntarily agrees to assign any paid capital credits to HOTEC if the member cannot be located within three (3) years after payment is issued. If you do not agree to this agreement, you may cross this section out and initial it. This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at progam.intake@usda.gov. You agree, in order for HOTEC to service your account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or emails, using any email address you provide us. Methods of contact may include using pre-recorded or artificial voice messages and/or the use of an automatic dialing device, as applicable. Applicant Signature Sign above Other Occupant or Joint Member Other or Joint Other Joint Date of Birth Social Security or Tax ID # Driver License # Copy of Driver License One file only.100 MB limit.Allowed types: gif, jpg, png, svg. Cell Phone Other or Joint Business Phone Other or Joint Other Contact or email Joint Applicant Signature Sign above HOTEC has my permission to run a credit check. Yes No I will pay a deposit. Do not run a credit check. Yes No Membership Fee $5 Connect/Transfer Fee $50 Pay Now Bill Warning message If you have not heard from a representative of Heart of Texas Electric within 24 hours of submitting your form, please contact our office at 1-800-840-2957. 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