You may also download the 业务 Service Application (PDF). Type of 业务(必需) 公司 伙伴关系 Other - please describe 业务 名字(必需) Mailing 添加ress(必需) Street 添加ress 添加ress Line 2 城市 状态 阿拉巴马州阿拉斯加American Samoa亚利桑那州阿肯色州加州科罗拉多州康涅狄格特拉华州District of Columbia佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰Massachusetts密歇根明尼苏达州密西西比州密苏里州蒙大拿内布拉斯加州内华达New Hampshire新泽西新墨西哥纽约North CarolinaNorth DakotaNorthern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州Pennsylvania波多黎各罗德岛州South CarolinaSouth Dakota田纳西州德州犹他州U.S. Virgin Islands佛蒙特州维吉尼亚州华盛顿West 维吉尼亚州威斯康辛州怀俄明Armed Forces AmericasArmed Forces EuropeArmed Forces Pacific 邮政编码 业务 Phone(必需)其他手机传真号码电子邮件 业务 License Number(必需) Federal Tax ID Number(必需) Has this business been a member of GVEA in the past?(必需) 是的 No 位置?(必需) Street 添加ress 添加ress Line 2 城市 状态 阿拉巴马州阿拉斯加American Samoa亚利桑那州阿肯色州加州科罗拉多州康涅狄格特拉华州District of Columbia佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰Massachusetts密歇根明尼苏达州密西西比州密苏里州蒙大拿内布拉斯加州内华达New Hampshire新泽西新墨西哥纽约North CarolinaNorth DakotaNorthern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州Pennsylvania波多黎各罗德岛州South CarolinaSouth Dakota田纳西州德州犹他州U.S. Virgin Islands佛蒙特州维吉尼亚州华盛顿West 维吉尼亚州威斯康辛州怀俄明Armed Forces AmericasArmed Forces EuropeArmed Forces Pacific 邮政编码 位置 you are applying for (street address)(必需) Street 添加ress 添加ress Line 2 城市 状态 阿拉巴马州阿拉斯加American Samoa亚利桑那州阿肯色州加州科罗拉多州康涅狄格特拉华州District of Columbia佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰Massachusetts密歇根明尼苏达州密西西比州密苏里州蒙大拿内布拉斯加州内华达New Hampshire新泽西新墨西哥纽约North CarolinaNorth DakotaNorthern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州Pennsylvania波多黎各罗德岛州South CarolinaSouth Dakota田纳西州德州犹他州U.S. Virgin Islands佛蒙特州维吉尼亚州华盛顿West 维吉尼亚州威斯康辛州怀俄明Armed Forces AmericasArmed Forces EuropeArmed Forces Pacific 邮政编码 细分 批号 Block Number Inside 城市 Limits?(必需) 是的 No 哪个城市?(必需) Inside Fairbanks North Star Borough?(必需) 是的 No 热的类型(必需) 石油 电 木 煤炭 Other - please describe Type of Building(必需) 房子 活动房屋 公寓 公寓 业务 Other - please describe Please describe the business(必需) Number of meters applying for(必需)(Each meter will be a separately billed account) Date you wish to assume this account(s) (mm/dd/yyyy)(必需) 月 一天 一年 仪表编号 and 读(必需)Click the + button to add a new row仪表编号读 添加 删除Is this a rental property?(必需) 是的 No Are you the:(必需) 老板 In process of purchasing 房东 代理 Other - please describe 老板 or 代理's 名字(必需) 老板 or 代理's Mailing 添加ress(必需) Street 添加ress 添加ress Line 2 城市 状态 阿拉巴马州阿拉斯加American Samoa亚利桑那州阿肯色州加州科罗拉多州康涅狄格特拉华州District of Columbia佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰Massachusetts密歇根明尼苏达州密西西比州密苏里州蒙大拿内布拉斯加州内华达New Hampshire新泽西新墨西哥纽约North CarolinaNorth DakotaNorthern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州Pennsylvania波多黎各罗德岛州South CarolinaSouth Dakota田纳西州德州犹他州U.S. Virgin Islands佛蒙特州维吉尼亚州华盛顿West 维吉尼亚州威斯康辛州怀俄明Armed Forces AmericasArmed Forces EuropeArmed Forces Pacific 邮政编码 老板 or 代理's Phone Number(必需)Does this meter serve anyone using a life support system?(必需) 是的 No 名字 of person using life support system(必需) Type of equipment used(必需) Third Party NotificationYou may designate a third party to receive a copy of any termination notice regarding disconnections initiated by GVEA. Some of the information this notice will contain includes the name and address of the member whose service is to be disconnected, the service address, the date of disconnection, and explanation of the reason for the proposed disconnection, and where appropriate, a statement of the amount of the delinquent bill. This designation does not entitle the party named to act on behalf of the member.Designate a third party?(必需) 是的 No Third Party 名字(必需) 第一个 最后的 Third Party Mailing 添加ress(必需) Street 添加ress 添加ress Line 2 城市 状态 阿拉巴马州阿拉斯加American Samoa亚利桑那州阿肯色州加州科罗拉多州康涅狄格特拉华州District of Columbia佛罗里达乔治亚州关岛夏威夷爱达荷州伊利诺斯州印第安纳州爱荷华州堪萨斯肯塔基州路易斯安那州缅因州马里兰Massachusetts密歇根明尼苏达州密西西比州密苏里州蒙大拿内布拉斯加州内华达New Hampshire新泽西新墨西哥纽约North CarolinaNorth DakotaNorthern Mariana Islands俄亥俄州俄克拉何马州俄勒冈州Pennsylvania波多黎各罗德岛州South CarolinaSouth Dakota田纳西州德州犹他州U.S. Virgin Islands佛蒙特州维吉尼亚州华盛顿West 维吉尼亚州威斯康辛州怀俄明Armed Forces AmericasArmed Forces EuropeArmed Forces Pacific 邮政编码 Third Party Phone(必需)Please list all 合作伙伴 and their mailing addresses(必需)Click the + button to add a new row名字Social Security NumberMailing 添加ress 添加 删除Please list the 2 persons who are authorized to vote on behalf of the business(必需)(They will also be able to transact business on the account) Click the + button to add a new row 添加 删除Please list any officers, 董事, 合作伙伴, or individuals that you wish to authorize to transact business on this account(必需)Click the + button to add a new row 添加 删除同意(必需) I certify that all the information given above is true and correct to the best of my knowledge and I agree to comply with the articles of incorporation and bylaws of the Association and any rules and regulations adopted by the Directors. I understand that a misstatement in this application may result in GVEA refusing to provide service, disconnecting service, cancelling any membership or all of these results. 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 Electronic Signature (Full 名字)(必需) Applicant Position/Title(必需) 验证码名字This field is for validation purposes and should be left unchanged.
