You may also download the Business Service Application (PDF). Type of Business(Required) Corporation Partnership Other - please describe Business Name(Required) Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Business Phone(Required)Other PhoneFax NumberEmail Business License Number(Required) Federal Tax ID Number(Required) Has this business been a member of GVEA in the past?(Required) Yes No Location?(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Location you are applying for (street address)(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Subdivision Lot Number Block Number Inside City Limits?(Required) Yes No Which city?(Required) Inside Fairbanks North Star Borough?(Required) Yes No Type of Heat(Required) Oil Electric Wood Coal Other - please describe Type of Building(Required) House Mobile Home Apartment Condo Business Other - please describe Please describe the business(Required) Number of meters applying for(Required)(Each meter will be a separately billed account) Date you wish to assume this account(s) (mm/dd/yyyy)(Required) Month Day Year Meter Number and Read(Required)Click the + button to add a new rowMeter NumberRead Add RemoveIs this a rental property?(Required) Yes No Are you the:(Required) Owner In process of purchasing Renter Agent Other - please describe Owner or Agent's Name(Required) Owner or Agent's Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Owner or Agent's Phone Number(Required)Does this meter serve anyone using a life support system?(Required) Yes No Name of person using life support system(Required) Type of equipment used(Required) Third Party NotificationYou may designate a third party to receive a copy of any termination notice regarding disconnections initiated by GVEA. Some of the information this notice will contain includes the name and address of the member whose service is to be disconnected, the service address, the date of disconnection, and explanation of the reason for the proposed disconnection, and where appropriate, a statement of the amount of the delinquent bill. This designation does not entitle the party named to act on behalf of the member.Designate a third party?(Required) Yes No Third Party Name(Required) First Last Third Party Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Third Party Phone(Required)Please list all partners and their mailing addresses(Required)Click the + button to add a new rowNameSocial Security NumberMailing Address Add RemovePlease list the 2 persons who are authorized to vote on behalf of the business(Required)(They will also be able to transact business on the account) Click the + button to add a new row Add RemovePlease list any officers, directors, partners, or individuals that you wish to authorize to transact business on this account(Required)Click the + button to add a new row Add RemoveConsent(Required) I certify that all the information given above is true and correct to the best of my knowledge and I agree to comply with the articles of incorporation and bylaws of the Association and any rules and regulations adopted by the Directors. I understand that a misstatement in this application may result in GVEA refusing to provide service, disconnecting service, cancelling any membership or all of these results. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Applicant Electronic Signature (Full Name)(Required) Applicant Position/Title(Required) EmailThis field is for validation purposes and should be left unchanged.
