Excelsior Electric Membership Corporation Application for Membership/ Additional Service

The undersigned (hereinafter called the "Applicant") here by applies for membership in/additional services from, and agrees to purchase electric energy from EXCELSIOR ELECTRIC MEMBERSHIP CORPORATION (hereinafter called the "Cooperative"), upon the following terms and conditions listed below:

1. The applicant if not already is a member will pay to the Cooperative with this application a membership fee of $25.00. Any portion of said membership fee not applied to the payment of bills due the Cooperative shall be refunded to the applicant after termination of services. A nonrefundable account establishment fee of $ will also be required for each meter served.

2. The applicant will comply with and be bound by the provisions of articles of incorporation, By-Laws, and Service Rules and Regulations now in effect and as may from time to time be adopted by the Cooperative.

3. Applicant shall, when electrical energy becomes available and the meter installed, purchase from the Cooperative all central station electric energy used on the premises described below or such other premises for which applicant may apply for service. The applicant: (1) agrees to pay for service consumed at full applicable rate; (2) agrees to monitor its electric statements and notify the Cooperative of any discrepancies; (3) agrees to pay any amounts determined to be due as a result of underbilling regardless of whether such underbilling resulted from the Applicant's conduct or not; (4) agrees to pay at least the minimum monthly charge specified in the applicable rate for the applicant's service.

4. After any termination membership, the undersigned Applicant may by the sole act of paying a new membership fee and any accounts still owed to the Cooperative, renew and reactivate this application to the same effect as if it had been newly and identically executed on the date of such payment or payments.

5. After termination of service, the Cooperative has the right to transfer all meter deposits, membership fees and account balances to any active account of the Applicant

6. At the request of the Cooperative the unsigned, if an owner of an interest in the premises to be served, will grant to the Cooperative the necessary easement and the rights to construct, operate, maintain and repair its lines and all equipment connected or used in connection therewith upon, along, across, over and will execute and deliver to the Cooperative any grant or instrument which the Cooperative shall deem necessary or convenient for all or any said purposes.

7. In applying for membership to the Cooperative, I am applying for subscription to its member newsletter at an annual rate of $1.00 per year.

The acceptance of this application by the Cooperative shall constitute an agreement and contract between the applicant and the Cooperative, and in further consideration of said acceptance and the installation of facilities by the Cooperative, such contract for electric service shall continue in force for a minimum of year(s). (initials), from the date service is made available by the Cooperative.