Service InformationService Address(Required)What address would you like to start service at? Street Address City Effective Date (MM/DD/YYYY)(Required)If you need to back-date this request, we can only accommodate a request back to the 1st of the current month. Month Day Year Buying or renting?(Required) Buying Renting BuyingWho are you purchasing from?Realtor Name & AgencyRentingProperty Owner/ManagerProperty Owner Phone NumberThis field is hidden when viewing the formSection BreakAre you currently an active member of VEC? Yes No Applicant InformationApplicant(Required) First Last Primary Phone Number(Required)Email(Required) Will there be a co-applicant?(Required) Yes No Co-Applicant Name(Required) First Last Phone NumberEmail(Required) Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code All new members are required to sign a membership application and agreement and pay a security deposit. Deposit amounts may vary based off number of meters and/or usage history at the location you are taking over. How would you like your new member packet sent to you? Email (E-Signature) Mail Please note: If you select email and have an application and co-applicant above, we will need an email address for each person on the member. Please make sure both applicant and co-applicant email addresses are complete in the section above. Membership Application Mailing Address(Required)Choose to use the same as above, or enter a one-time mailing address. Same as previous Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Active Member InformationName on Membership(Required) First Last Account # / Invoice Group #This field is hidden when viewing the formSection BreakWhat is the best method of contact if VEC has any follow-up questions?(Required) Phone Email Text Phone Number(Required)Email(Required) Cell Phone Number(Required)Applicant Consent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Applicant Signature (Full Name)(Required)PhoneThis field is for validation purposes and should be left unchanged.