CommentsThis field is for validation purposes and should be left unchanged.Date when the agreement is made on (mm/dd/yyyy):(Required) Month Day Year The agreement is made between Mille Lacs Energy Cooperation, and:(Required)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 Account (Location) Number:(Required) 50 W LED light – Cost $10.20 per month The Cooperative agrees to install your choice above. The light will be installed on the premises of the above named patron at a location mutually agreed upon. The light shall be placed on the Cooperative’s poles only. To be “Dark Sky Compliant”, all LED lights are installed without a refractor shield. The Cooperative shall furnish, install, and maintain the light during a normal work day. The light shall remain the property of the Cooperative.This agreement shall remain effective for a minimum of 1 year following the date of installation. After one year of service, termination shall be by written notice by either party at least 30 days prior to disconnection. The parties hereto have executed this Agreement as of the day and year indicated above. It is the member's responsibility to call when the light needs repair.Member Consent 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.Member Electronic Signature (Full Name)(Required)Additional Information:Please indicate which position on the pole you prefer to have the light installed. (North, East, South, or West)
