WEST KENTUCKY RURAL ELECTRIC COOPERATIVE CORPORATION
SERVICE/MEMBERSHIP APPLICATION

SINGLE

JOINT

NEW MEMBER

CURRENT MEMBER

 

For Office Use

    Route, Account, Tenant
     Membership Number      
         Deposit Number          
        Received by / Date

 
Applicant (husband or single)  


Social Security No. (husband or single)


Applicant (wife) 


 Social Security No. (wife)


Street, Route, or Box No.


Telephone Number


City, State, Zip Code

Are Applicants Owners  Yes
of Described Property?     No

If billing address is different from above show name and address:

COMMENTS:                
 __________________________
 __________________________
 __________________________
 __________________________
 __________________________
 __________________________

Have you had prior service with us? If so, where?

What is the name and address of your employer?

            

RETURN TO:    West Kentucky RECC 
P.O. Box 589              
Mayfield, Ky 42066     


NOTE: A membership which is applied for in a single name can be voted only by that member whose name is on the membership records. Should a spouse desire to vote, both husband and wife should apply for a joint membership before the day of the next Annual Meeting at one of the offices of West Kentucky Rural Electric Cooperative Corporation or return this application by mail to the Mayfield office at the address above.

Should you and your spouse desire to apply for a joint membership or transfer your current single membership to a joint membership, both spouses should fill out and sign this application agreeing to the terms and conditions specified on the reverse side of this application form.

IMPORTANT: APPLICATION MUST BE SIGNED ON REVERSE SIDE.