New Service Agreement- Minnesota

Current Applicant Information
Additional Information
Cooperative Requirements
Sign and Submit
Complete

Indicates required field

All sections and pages of this agreement must be completed before staking appointment can be set.

This is an agreement between MiEnergy Cooperative (hereinafter called the "Cooperative" and the "Applicant," an individual, partnership, corporation (check one). The Applicant attests to be the owner of the service location OR has the authority to make this application and execute all the necessary documents.

Business or Individual

Name of Business

Name of Applicant(s)

APPLICANT'S MAILING ADDRESS

Address

City/Town

State

ZIP Code

Primary Phone Number

Cell Phone Number (if different than primary number)

Email

Please Confirm Your Email

911 ADDRESS OF NEW SERVICE

Same as above

Address

City/Town

State

ZIP Code

County

Township

Section

Parcel ID# (if known)

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