Application for Service

Please complete the below application to apply for new service.  Please be sure that you provide us with correct phone numbers and e-mail addresses as we will need to contact you prior to connecting the service in order to confirm location, payment and connection date. A copy of your ID will also be required. We need at least one business day's notice to connect the service(s).  

If you have any questions regarding new service, please contact our office during normal business hours, Mon - Fri 8 am to 4 pm, 951-763-4333 or aec@anzaelectric.org.  
  
Note: All fields with the asterisk (*) are required.

 
Date Service is Desired:  *  
Type of Request:   *
Applicant:
Applicant's First Name:		   *
Applicant's Last Name:   *
Applicant's Middle Initial:  
SSN:--  *
Driver's License Number:  *
License State:  
Birth Date:    
Employer:  
Have you ever had service with Anza Electric Cooperative?  *
If yes, name on account:  

Mailing Address:
Please enter the address where bills should be sent:
Street Address/P.O. Box:  *
City:  *
State:  *
Zip Code:   *

Service Address:
Please enter the address where service is required:
Service Address:  
Service Type (Construction Required or Existing Service):  
Comments:  
E-mail:  *
Confirm E-mail:  *
Phone Number (landline):--   *
Cell Phone:--  
Co Applicant:
Co Applicant Name:		 
SSN:-- 
Co Applicant Driver's License:  
Co Applicant License State:  
Co Applicant Birth Date:    
Co Applicant Employer:  
Phone Number (landline):  
Cell Phone:  
Email Address:  

Online Portal:
As one of our services, we provide an online portal for viewing/paying bills and to manage your account. If you'd like to use this service, you can specify an Internet Password and Password Hint at this time. For security purposes, please specify an Internet Password that is at least 5 characters in length.
Online Portal Password:  
Confirm Internet Password:  
Password Hint:

Fee & Deposit Information:
In addition to a $25.00 Establishment Fee (per service) a security deposit may be required based on the results of a credit check. We will contact you once the credit check has been completed to let you know how much deposit (if any) will be required.

Establishment Fee:  

Life Support: If anyone in the household is on life support, please complete the next 2 fields.
Type:		  
Hours of Back up (oxygen):  
If there is an outdoor security light at this location would you like it connected? *Monthly fees range from $9 to $16. We will let you know the exact cost once we know your location.  *
Property Information:
Property Owner's Name:		  *
Owner's Telephone Number:  *
Owner's Address:  *
Do you own or rent at the service location?   *
Would you like to participate in Operation Roundup?
Click here to learn more about the community program.		   *
Please select your preferred billing method:   *
 
I have read and agree to the terms listed below.
I/We understand that my/our SSNs will be used to run a "soft" credit check through Online Utility Exchange to determine credit worthiness and validates identity and will not affect my/our credit.
I/We understand and agree that any credit granted shall be paid promptly in accordance with terms and agreements, and, in the event of default, to pay reasonable collection charges and/or attorney fees
I/We understand that any phone numbers (landline or mobile) or email addresses on the application or collected during the course of business may be used for outage notification, collection calls or
special events. AEC will not sell this information nor will this information be used for solicitation purposes. By providing any telephone number for contact purposes, I/we confirm that the telephone
numbers belong to myself/us and not a family member or other third party.  I/we agree that AEC or their agents or contractors can call/me at the number using an automatic telephone dialer and
that a pre-recorded message may be left or a text message maybe sent. I /we agree to notify AEC if any phone number or email addresses are given up or changed.

1.   The undersigned (hereinafter called the Applicant) hereby applies for membership in and agrees to purchase electric energy from ANZA ELECTRIC COOPERATIVE, INC – ANZA, CA. 
2.   The applicant agrees to comply with and be bound by the Articles of Incorporation, the bylaws of the Cooperative and any amendments thereto, and such Rules and Regulations as may be adopted from time to time by the Cooperative. 
3.   Applicant agrees, as soon as electric energy shall be available, to receive service from the Cooperative for all electric energy used on the premises specified in the application for membership except co-generation, and shall pay therefore monthly rates which from time to time are to be fixed by the Board of Directors; provided, however, that the Board of Directors may limit the amount of energy which the Cooperative shall be required to furnish to any one member. Each member shall pay to the Cooperative such minimum amount per month regardless of the amount of electric energy consumed, as shall be fixed by the Board of Directors from time to time and shall pay all amounts owed to the Cooperative as and when the same shall become due and payable. 
4.   Applicant agrees: 
a.   to pay the Cooperative a Service Establishment charge as set by the Board of Directors. 
b.   to deposit with the Cooperative such consumers deposit as is required by the Board of Directors; it being expressly understood that such deposits shall be non-interest bearing and shall be refunded to the Applicant as specified by the bylaws of the Cooperative. 
5.   The Applicant will cause his premises to be wired in accordance with National Electrical Code Specifications, Riverside County and approved by the Cooperative. 
6.   It is expressly understood that under law, Applicant’s private property cannot be attached for any debt or liabilities of the Cooperative and that by becoming a member, Applicant assumes no personal liability or responsibility whatsoever for such debts. 

I have read and agree to the terms under the CONDITIONS OF SERVICE.

Review Residential & Commercial Rate Sheet here.  I have reviewed the Rate Sheet and am aware of the monthly fees.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *