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First Name:
Last Name:
First name of additional member (if joint membership):
Last name of additional member (if joing membership):
Type of Membership:
SS# or Federal ID#:
SS# or Fed. ID# of other member (if joint membership):
Mailing address:
City  
State
Zipcode
Main Phone (including area code, no spaces):
Alternate Phone (including area code, no spaces):
Email Address:*  
Which method would you like us to use to confirm your membership application?:
 
Name:
Phone (including area code, no spaces):
Type of structure: 
Service Physical Address
Name of closest neighbor with power:
Will you have electric heat?
If yes, will it be off-peak?
Have you been on our lines before?
If you are a current member, would you like this account billed with your present account?
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Beltrami Electric Cooperative, 4111 Technology Dr NW, PO Box 488, Bemidji, MN 56619-0488
Phone:  218-444-2540 or 1-800-955-6083 Fax:  218-444-3676 email:  info@beltramielectric.com
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