HEADQUARTERS

1940 Madison Street P.O. Box 3300

Clarksville, TN 37043-3300
1-800-987-2362
www.cemc.org

General Power Service Agreement

Name:
KEVIN M SLOAN
Address:
143 CORNERSTONE BLVD
City, State, Zip: PORTLAND, TN 37148

Customer Number:
Account Number:
Home Phone #:

4434122
4434122002
(270) 535-5828

Service Address: 300 B BRILEY LN

The applicant applies to the Cumberland Electric Membership Corporation (Herein called the "Cooperative") for
membership therein and for electric service and agrees that:
This account will be used for non-residential General Power purposes.
Place a circle around the structure below that best describes the entity applying for service:
Individual

Sole-Proprietorship

Partnership

LLC

Corporation

Not-for-Profit Organization

Other (please describe)

Place a check in the boxes below, if applicable:
Service will begin as a temporary service for construction purposes but will be converted to a permanent General
Power service upon completion.
This application will extend to any additional service locations established or placed in the above applicants name.
All provisions herein will be applicable with the exception of specific deposit language.
The applicant must notify the Cooperative if there is a change in the person or entity responsible for this account, or a
change in the contact information associated with this account. It is the further responsibility of the applicant to notify the
Cooperative of changes in telephone number(s) and/or the email address associated with this account.
Membership Fee
The applicant will pay $10.00 which will constitute the membership fee to the Cooperative. This fee will be refunded in full
on the final bill when electric service is no longer desired.
Deposits
A security deposit or other form of adequate assurance is required before electric service can be connected. A security
deposit based upon the service entrance size of the location or contract demand will be held until such time as the
Cooperative is properly notified of cancellation of service, at which time the deposit balance will be refunded.
Accounts are subject to continual credit rating assessments. If an account exceeds an acceptable credit rating based on
payment history with the Cooperative the standard deposit requirement becomes activated. For General Power accounts,
the deposit will be billed in one (1) installment.
General Power deposits shall accrue interest on the full deposit balance after 12 months; which will be applied as a credit
upon account closing. The interest rate will be adjusted annually to the average passbook savings rate as of October 31.
Upon settlement of the final bill the deposit will be refunded in full to the member. In lieu of full payment of the final bill, the
amount of the final bill will be deducted from the deposit and the balance will be returned to the member, if applicable.

*4434122QXKEVIN M SLOAN*
4434122002 KEVIN M SLOAN

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HEADQUARTERS
1940 Madison Street P.O. Box 3300
Clarksville, TN 37043-3300
1-800-987-2362
www.cemc.org
Authorization
Identification of authorized parties must be provided to the Cooperative. Authorized parties will have the authority to
inquire about existing accounts, make changes to accounts, establish new services (or disconnect existing services) in the
entities name.
Payment for Service
The undersigned hereby makes application for utility service(s) and agrees to pay for said service(s) as measured by the
Cooperative metering devices in accordance with the applicable rates and charges specified in the Cooperatives rate
schedule for the above account and any subsequent accounts established.
The undersigned assumes responsibility of service beginning from connection date or until the Cooperative is properly
notified of cancellation of service, and agree that all billing rendered by the Cooperative shall be due and payable as per
the bill. Failure to receive a bill does not release a member from payment obligations.
Disconnection of Service
The Cooperative reserves the right to disconnect electric service to any member for violations of Cooperative Rules and
Regulations, Policies, Operating Bulletins, or potential safety issues. The Cooperative will disconnect electric service to
any consumer who fails to pay his/her electric bill within the allotted time following standard disconnect procedures.
Notice of termination shall be provided in accordance with law and regulations.
The termination procedure may be carried out manually via Cooperative personnel or remotely via the use of remote
disconnect technology. This technology may be deployed at any service location deemed as necessary for the business
function of the Cooperative.
Accounts that are disconnected for non-payment will be required to pay the full delinquent balance and the appropriate
reconnection fee prior to having service restored.
The Cooperative will consider payments to be received when they arrive at our offices or retail lockbox location and are
posted to member accounts. The post mark date on mailed payments will not be recognized as the payment receipt date.
Right of Way/Easements
The Cooperative is hereby granted unimpeded access to all equipment and infrastructure for the purposes of
maintenance or repair. The property may be accessed for reasons including but not limited to; meter maintenance or
exchange, line repair, security light maintenance, tree trimming, and any other activity reasonably necessary for the
operations of the cooperative. Each member shall, upon being requested so to do by the Cooperative, execute and deliver
to the Cooperative grants of easement or right of way over, on and under such lands owned or leased by the member,
and without charge in accordance with such reasonable terms and conditions, as the Cooperative shall require for the
furnishing of electric service to him/her or other members or for the construction, operation, maintenance or relocation of
the Cooperative's electric facilities. The Board of Directors may require from applicants for membership the return of any
payments previously made to such applicants for easements.
Communication with Member
By providing the Cooperative my telephone number(s) and other contact information, I agree that the Cooperative may
contact me for any business related purpose. The method of contact will include but not be limited to the use of an
automatic telephone dialing system; voice or prerecorded message; text message; email; other electronic
communications.
I agree that the Cooperative may place such calls using an automated dialing/announcing technique. I agree that the
Cooperative may make such calls or text messages to a mobile telephone or other similar device. I agree that the
Cooperative may, for business purposes, training purposes, or to evaluate the quality of service, listen to and record
conversations I may have with the Cooperative.

4434122002 KEVIN M SLOAN

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HEADQUARTERS
1940 Madison Street P.O. Box 3300
Clarksville, TN 37043-3300
1-800-987-2362
www.cemc.org
Wiring and Inspections
By applying for electric service through the Cooperative, the applicant agrees to have all wiring on the premises done in
accordance with the National Electric Code and Tennessee Regulation No. 15. Applicant further agrees to have the
premises re-inspected by the State Electrical Inspector when the electric service has been inactive for at least 12
consecutive months or whenever there have been significant changes to the electrical system.
Customer Data
The Cooperative will keep and maintain all Personal Information in strict confidence, using such degree of care as is
appropriate to avoid unauthorized access, use or disclosure, while following all local, state and federal laws associated
with such Personal Information. The Cooperative may provide Personal Information to third parties for permitted
purposes, including but not limited to, industry related studies and analyses, compelled disclosure, government bodies
acting with the authority of law, any other industry related lawful activity.
Corporation Governance
The applicant agrees to comply with, and be bound by the charter of the Cooperative and such bylaws, rules, regulations,
policies, procedures, and bulletins as may be adopted by the Cooperative. Copies of those documents, as changed from
time to time, may be seen during business hours at the office of the Cooperative in Clarksville, TN or at www.cemc.org.

Please review the following pages and complete forms as applicable.

By signing below, I acknowledge having read and agree to the terms & conditions outlined above.

Signature of Primary Applicant

CEMC Representative

Signature of Additional Applicant

DL #: 091701898
4434122002 KEVIN M SLOAN

E-Mail PFTKev@gmail.com
2/4/16 1:33:11 PM

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HEADQUARTERS
1940 Madison Street P.O. Box 3300
Clarksville, TN 37043-3300
1-800-987-2362
www.cemc.org

Business Entity Authorization To Cumberland Electric Membership Corporation for

Membership/Service Application
I,

Name
Title
Name of Business Entity
organized and existing under the laws of

Tennessee
State

and having its principle place of business at

Address, City, Sate, Zip

hereby certify that the following information is in accordance with the provisions of the Business Entity. The above listed
business entity approves application for service/membership with Cumberland Electric Membership Corporation.

Signature

Print Name

The person named above is hereby authorized to sign on behalf of the Business Entity any contracts or forms for CEMC
and the above listed Business Entity will be responsible for payments of invoices. Invoices shall be mailed to the following
address;

Address, City, Sate, Zip

I further certify that this Business Entity is duly organized, existing, active, and in good standing pursuant to the laws of
the jurisdiction for which it exists.

President (Signature)

Print Name

Witness (Signature)

Print Name

Date

Tax ID

4434122002 KEVIN M SLOAN

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HEADQUARTERS
1940 Madison Street P.O. Box 3300
Clarksville, TN 37043-3300
1-800-987-2362
www.cemc.org

List of Authorized Parties

Account #: 4434122002
Please list those individuals authorized to make changes on this account or those accounts which may be established in
addition to this service:

Kimberly Sloan

I certify that the above listed names are authorized users.

President (Signature)
4434122002 KEVIN M SLOAN

Print Name
2/4/16 1:33:11 PM

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