Electrical Service Contract

In accordance with Federal guidelines we need a copy of the applicant(s): PHOTO ID
Accepted file types: jpg, jpeg, png, gif.
Request Date:


Hereby agrees to enter into a contract with Mission Valley Power (“MVP”) on the following terms and conditions.

Street Address
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3. General Connect/Transfer Fee or Reconnect Fee: $10.00 will be billed on first month’s bill
4. Rate schedule

Basic Charge applies to services that are billed with or without a meter


The Applicant consents to be bound by all the terms, conditions, fees and charges set forth above, by all provisions contained in MVP’s Operations Manual and federal regulations found at 25 C.F.R. Part 175 (including any revisions to the manual or regulations), and by applicable rate and fee schedules (that may change from time to time) available for review at MVP’s Pablo office.



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The Confederated Salish and Kootenai Tribes operate and manage the Bureau of Indian Affairs’ Flathead Agency Power division under the name “Mission Valley Power” pursuant to a contract authorized under the Indian Education and Self-Determination Act (25 U.S.C. 450f). MVP maintains its system records consistent with the federal Privacy Act (43 CFR Part 2, Subpart D). This information is being collected to determine the consumers’ electrical needs and will be used to determine consumption costs. Response to this request is required to obtain a benefit in accordance with 25 CFR 175. Failure to provide all or part of this information may preclude MVP from providing requested service(s).


OMB 1076-0021



APPLICANT (1)

APPLICANT (2)

Birthdate
Birthdate
I would like to use my E-mail address to receive outage notifications.


LIST NAMES & BIRTHDATES IF ELDERLY OR 5 YRS OF AGE & YOUNGER

Birthdate
Birthdate
Birthdate


LIST CLOSEST RELATIVE OR FRIEND NOT LIVING WITH YOU:

physical address:

36079 Pablo West Road
Pablo, MT 59855

mailing address:

PO 97
Pablo, MT 59855

phone contact:

p. 406.883.7900
p.406.675.7900

office hours:

Monday - Thursday:
7:00 am-5:30 pm