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301D- INDIVIDUAL/JOINT MEMBERSHIP APPLICATION
Preferred Membership Type (Select "Joint" to establish a Joint account)
*
Individual
Joint
Have you previously had an account (in your name) with Todd-Wadena Electric Cooperative before?
*
Yes
No
MEMBER INFORMATION:
First Name
*
Middle Initial
Last Name
*
Date of Birth
*
Social Security #
*
Phone Number
*
Type of Phone
*
Cell Phone
Home Phone
Additional Phone Number
Type of Phone
Cell Phone
Home Phone
Current Address
*
City
*
State
*
Zip
*
Email Address
*
Ethnicity
*
Black
Asian
White
Hispanic
Native American
Other
Prefer Not to Answer
Billing Address
*
City
*
State
*
Zip
*
CO-MEMBER INFORMATION
Co-Member First Name
*
Middle Initial
Co-Member Last Name
*
Date of Birth
*
Social Security #
*
Phone Number
*
Type of Phone
*
Cell Phone
Home Phone
Additional Phone Number
Type of Phone
Cell Phone
Home Phone
Current Address
*
City
*
State
*
Zip
*
Email Address
Ethnicity
*
Black
Asian
White
Hispanic
Native American
Other
Prefer Not to Answer