Clark Energy Cooperative Membership Application

Residential Service

Please fill out all sections completely to apply for membership and electric service.

Applicant Information
Co-applicant Information (if applicable)

By adding a co-applicant, who must be a legal spouse, you are creating a joint membership. Both the applicant and co-applicant will have equal rights to the account and any assigned capital credits.

Contact Information
Service Location Information
Select Service Description

If the service being requested has been inactive for 12 months, an electrical inspection will be required before service can begin.

Are you the owner or a tenant?
Please provide the owner's contact information
Have you ever had service with Clark Energy?
Will this service be your primary residence?

Please be sure to submit a Declaration of Domicile for this service.

Is there an outdoor light at this location?
Would you like to keep the outdoor light?
Deposit and Credit Check Authorization

A deposit will be required before service can begin on the account. However, this deposit may be waived if a satisfactory credit rating is obtained through a soft credit check.

Do you authorize Clark Energy to perform a soft credit check to determine if the deposit can be waived?
Please indicate who the credit check should be run on:
Account Preferences
Billing Preference
Do you wish to be enrolled in SmartHub? SmartHub is an online and mobile application that allows you to pay your bill, track your usage, and report outages.
Agreement and Signature

Please review the following documents:

Checking this box confirms the applicant has read and agrees to the terms and conditions and bylaws of Clark Energy Cooperative. 

I understand that checking this box and typing my name in the space provided below serves as my electronic signature. 

Sign above

Checking this box confirms the co-applicant has read and agrees to the terms and conditions and bylaws of Clark Energy Cooperative. 

I understand that checking this box and typing my name in the space provided below serves as my electronic signature. 

Sign above
Document Uploads

Please upload a clear photo of the front of the driver's license for both the applicant and co-applicant (if applicable).

One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png.
One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png.