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Member Information
Member Name
Enter name of primary member or business name, if applicable
Enter full name of primary member on account
Mailing Address
Enter current mailing address here
Service_address

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Contact phone number(s) (List all)
Contact phone number(s) (List all)
Joint Member Name

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Joint Member Contact Phone Numbers
Joint Member Contact Phone Numbers
Service Construction Information
Name of closest neighbor with power
This will assist us in finding the location of the property on our map. 
Township, Section, Range and Parcel ID
Please enter the E-911 Address for the location (if assigned)
An electric on-demand water heater will affect the size and cost of the electric service needed at the location.
An electric vehicle charger will affect the size and cost of the electric service needed at the location.

To facilitate the process of installing or changing your electric service, please complete the site sketch indicating placement of private facilities such as private electrical, water, well, sewer, telephone, gas, lift station pump lines, underground dog fences, sprinkler system lines, etc.


One file only.
20 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, jpg.

In order to complete an easement, Beltrami Electric Cooperative requires a copy of the property Warranty Deed or Reservation/Tribal Land assignment that includes the land owner's names and a legal description of the property. Right-of-way easements give Beltrami Electric Cooperative permission to install and maintain electrical equipment on your property.


One file only.
20 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, ppt, pptx, xls, xlsx, jpg.
Contractor Information
Name of Contractor
If you have a contractor for this project, please fill in their contact information here.
Name of Electrician
Electric Service Construction Terms & Conditions
  • I understand that as the owner, it is my responsibility to locate and expose any private lines before construction takes place. I will leave all markers intact and will not move. I will expose any water lines buried deeper than 48 inches do not have to be exposed.

  • I understand that the cooperative is not responsible for damages to private lines such as cable TV, satellite, private electrical, water, well, sewer, telephone, gas, lift station pump lines, underground dog fencing, or sprinkler system lines.

  • I understand that it is my responsibility to obtain and the clear right-of-way for this project.

  • I will pay for the cost of all permits and/or grant any easements required for this electric service and will help obtain any permits and/or easements necessary to construct the line.

  • I understand that this type of work will be done as construction crews are available, and that emergencies, such as outages, maintenance, and other necessary line construction will have priority over construction of services.

  • I understand that all quotes for contribution in aid of construction charges are only valid for the current construction season ending Dec. 31, and do not include any membership fee or deposits that may be due.

  • I understand that winter construction charges will apply for any service constructed between Nov. 1 and May 1 of each year, and will be in addition to the standard service charges.

  • I understand that services are energized at the time of construction. Billing for the monthly access charge will begin once a new service has been built and will continue for a minimum of 12 months. The access charge will be billed according to the current rate structure regardless of any energy used.

  • I understand that if my service cannot be energized at the time of construction, a meter reconnect fee will apply at the current reconnect rate. Any work in addition to energizing that cannot be completed will be considered a Service Improvement or New Relocation of Facilities and subject to the current rates.

  • I understand that if I request a disconnection before one continuous year of service, I will be billed the current access charge for the remaining months of that year will be billed to the member via a lump sum on final bill.

  • I understand that Beltrami Electric is not responsible for the restoration of property on a new construction site or requested service improvement.

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