New Member Questionnaire Communications ● New Member Questionnaire New Member Questionnaire Form Type of Membership ResidentialBusiness [group Residential]If Residential Single AccountJoint Account[/group] Service Address Date to Start Service [group Residential-Membership] Part 1: Primary Applicant Information Full Legal Name DOB S.S. # D. L. # Phone # Employer [group Joint-Account] Joint Applicant Information Full Legal Name DOB S.S. # D. L. # Phone # Employer [/group] [/group] [group Business] Part 2: Business Applicant Information Entity Name EIN # Principal Officer Phone # Have you or the business ever had Caney Fork Electric service? YesNo [group Yes] If yes, what was the service address? If yes, what name was the former account in? [/group] How would you like to receive your bill? (Please choose only one method) EmailPaper [group Email-group] Email Address [/group] [group Paper] PO Box or Street City State Zip [/group] Would you like to enroll in automatic bank draft? YesNo [/group] Initial Consent to check credit - The Applicant(s) signed below hereby give(s) consent for Caney Fork Electric Cooperative, Inc., or any credit bureau which it may designate, to obtain any and all information concerning the applicant(s)' obilgations and all other credit matters which may be required in connection with their application for electric service. Applicant's Signature Date Joint Applicant's Signature Date CFEC Employee Date Email
