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:

Meter No.

Account No.

The applicant(s) name(s)

Mailing Address

City

State

ZIP Postal Code

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

1. Applicant certifies that he/she is, (Choose one): Owner, Renter/Lessee, Manager of property located at: physical address for this service

Street Address

Choose Here

Owner

Renter/Lessee

Manager

2. Security Deposit: $500.00 or Excellent Credit Reference from current Elec. Utility for the last 12 months of service OR prepay for $60 (must fill out prepay agreement)

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

4. Rate schedule

Existing Area Light

Residential Basic Charge of $17.50/mo., $21.00/mo. for Prepay, Net Meters $20.00 mo

Small General Services Basic Charge of $17.50/mo., $21.00/mo. for Prepay, Net Meters $20.00

Large General Services Single-Phase Basic Charge is $32.50/mo

Large General Services Three-Phase Basic Charge is $53.25/mo., Net Meters $50.00 mo

Unmetered Services using kilowatt hours (UMS) Basic Charge is $17.50/mo. (Includes traffic lights, billboards, etc)

Large Commercial Basic Charge is $153.83/mo

Irrigation Basic Charge of $5.00/Mo

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.

Applicant (1) Name (PLEASE PRINT):

Applicant (2) Name (PLEASE PRINT):

Applicant (1) Signature

Applicant (2) Signature

Date

Name of Business (only if applicable) PLEASE PRINT

Officer of Business (PLEASE PRINT)

Date

Signature of Business Officer (Authorized to Contract on Behalf of Business)

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)

Name

Home Phone

Message Phone Number

Employer

Employer Phone Number

Social Security Number

Birthdate

Driver's License #

State

Email Address

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

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

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

Name

Birthdate

Name

Birthdate

Name

Birthdate

LIST CLOSEST RELATIVE OR FRIEND NOT LIVING WITH YOU:

Name

Phone

How Related

Name

Phone

How Related

Fill out the form below online or click here to download the form

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

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

APPLICANT (1)

APPLICANT (2)

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

LIST CLOSEST RELATIVE OR FRIEND NOT LIVING WITH YOU:

physical address:

mailing address:

phone contact:

office hours: