Business Membership Application

Business

Business Name(Required)

Service Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address(Required)

Same as service address

Business Primary Phone(Required)

Alternate Phone

Email(Required)

Federal Tax I.D.(Required)

Business License Number(Required)

Date on which you wish to assume responsibility for the service. This date must fall within normal business days (Monday-Friday) and exclude holidays and weekends.(Required)

By disclosing my telephone number(s) to Golden Valley Electric Association (GVEA), I 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 the contact information.

Ownership

Are you the owner of the property?(Required)

Yes

In process of purchasing?(Required)

Yes

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

Name(Required)

First Last

Phone(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Please list officers, directors, partners or individuals that you authorize to transact business on behalf of the membership

Click the + button to add a new row

If anyone at this location is using a life support system, please contact our credit office at (907) 452-1151.

Electronic Signature (Full Name)(Required)

Position/Title(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.

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Name

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