An individual who requests a joint membership with Golden Valley Electric Association (GVEA) may do so by having both parties complete this form. Upon acceptance by the Association, the membership shall be deemed a joint membership. A joint membership allows either party to conduct business on behalf of the membership. This form should only be completed if you are already a member with an active account. Provide a phone password or PIN to be used for identification verification in lieu of a Social Security Number or Document Locator Number (optional)(PIN must be between 4 to 6 numbers in length) ApplicantName(Required) First Last Social Security Number Driver's License Number Driver's License State Date of Birth (mm/dd/yyyy)(Required) Month Day Year Email(Required) Primary Phone(Required)Alternate PhoneSpouse/Co-applicantSpouse or Co-applicant(Required) Spouse Co-applicant Name(Required) First Last Social Security Number Driver's License Number/State Date of Birth (mm/dd/yyyy)(Required) Month Day Year Email(Required) Primary Phone(Required)Alternate PhoneI am consenting to receive information relating to my account(s) and/or other GVEA business via automated calls, texts or email on any number (or any future telephone numbers) which I may provide to GVEA. I understand that I am responsible for notifying GVEA of any changes to my personal contact information. Service Address(Required)Click the (+) to add another address. Add RemoveOwnershipAre you the:(Required) Owner Other In process of purchasing?(Required) Yes No Owner's Name(Required) Owner's Contact Information(Required) Third Party Notification You 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.Third Party?(Required) Yes No Name(Required) First Last Phone(Required)Email(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 Consent(Required)Members may be required to pay fees upon application. The Association also requires a separate deposit for each meter, unless an individual can provide a letter from the utility which last provided comparable service, stating that within the last 12 months of continuous service, the applicant has not been past due in payment more than twice, has not been delinquent in payment in the last 6 months, and the service must have been provided within the last two years. A deposit may be waived upon application of service for returning member upon satisfaction of these same criteria from the Association’s records.In connection with signing this application I/we give GVEA permission to run an Equifax Energy Risk Assessment, to determine if a security deposit is required and for identification purposes. *If a social security number is not provided, further identification will be required.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 certify that all the information given above is true and correct to the best of my knowledge. By accepting service from GVEA, the applicant(s) agree to comply with Golden Valley Electric Association Bylaws, Articles of Incorporation, Policies, Operating Tariff and regulations adopted by the Directors. I hereby verify the information to be true and complete and agree to the terms and conditions. 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.If anyone at this location is using a life support system, please contact our credit office at (907) 452-1151.Membership Holder Electronic Signature (Full Name)(Required) Spouse/Co-applicant Electronic Signature (Full Name)(Required) Our team will review this information and respond with any questions within 2-4 business days. If your request is urgent please contact one of our representatives at (907) 452-1151 during our normal business hours of Monday-Friday, 8:30AM – 4:30PM, except holidays.EmailThis field is for validation purposes and should be left unchanged.
