PLEASE READ AND COMPLETE THE FORM BELOW

1. The undersigned (hereinafter referred to individually and jointly as “Applicant”) hereby applies for membership in and agrees to purchase electric energy from Hendricks Country Rural Electric Membership Corporation d/b/a Hendricks Power Cooperative (hereinafter referred to as the “Cooperative”) for consumption at the address and location identified below (hereinafter, the “Premises”).
    
2. Applicant hereby represents and warrants to the Cooperative that Applicant is the owner of the Premises or has a sufficient leasehold interest therein entitling Applicant to the use and occupation thereof.
    
3. Applicant agrees to comply with and be bound by rights, obligations and liabilities in the Cooperative’s Articles of Incorporation, By-Laws, Policies, Rate Schedules, Rules and Regulations, as the same may be adopted or amended from time to time by the Cooperative (hereinafter, the “Governing Documents”).
    
4. Upon acceptance of this application by the Cooperative, Applicant shall pay the Cooperative a refundable non-interest-bearing membership fee in the amount of $20.00, which membership fee shall only be refundable at the times specified in and in accordance with the Governing Documents.
    
5. Applicant agrees to purchase and pay for all electric energy for use at the Premises from the Cooperative at rates  determined from time to time by the Cooperative (including a minimum service charge regardless of the number of kilowatt hours consumed) in accordance with the Governing Documents.
    
6. Applicant agrees that upon request by the Cooperative, the Applicant shall execute and deliver to the Cooperative grants of easement or right-of-way over, on or under such lands owned or leased by the Applicant as the Cooperative shall require for the furnishing of electric and communication service to the Applicant or to other members of the Cooperative for the construction, operation, maintenance or relocation of the Cooperative’s electric facilities.
    
7. Applicant agrees to receive relevant information regarding electric service, including outage and billing matters, through a contact telephone number (wireless or wireline) provided below using automated calls and messages, but Applicant understands he or she may revoke any agreement in providing a contact number.
    
8. By checking the box below and submitting this application electronically to the Cooperative, the Applicant agrees that such act shall have the legal effect of a signature and consents to contract electronically for membership in the Cooperative and for the purchase of electric energy from the Cooperative for consumption at the Premises.