Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Year 2018 2019 2020 2021 2022
- Select - Individual Joint Corporation Government Body Partnership Church/School Other
Applicant First Name
Applicant Middle Initial
Applicant Last Name
Business Name (if applicable)
Cell Phone 2
Preferred Phone Number
- Select - Home Phone Cell Phone Cell Phone 2 Miscellaneous Phone
In the event St. Croix Electric must contact you, which phone number do you prefer the Co-op to call?
Secondary Phone Number
- None - Home Phone Cell Phone Cell Phone 2 Miscellaneous Phone
If you or a designated representative cannot be reached at the preferred phone number listed, the Co-op has permission to try to reach you on this additional number.
Co-Applicant First Name
Co-Applicant Middle Initial
Co-Applicant Last Name
Co-Applicant Home Phone
Co-Applicant Cell Phone
Property Location Address & City/State/Zip
Current Mailing Address & City/State/Zip (can be "same" if approrpriate)
If you run a home business, estimate percentage used for business purposes
Property Owner (if different than above)
Property Owner Phone
Property Owner Address
Property Owner City, State & Zip
Voluntary Member Identification
The Rural Utilities Service requires St. Croix Electric Cooperative to provide statistical reports analyzing the composition of our membership. The data is being collected for federal government reporting purposes only. Please select the option most appropriate in describing your background.
By clicking on the "Submit" button, I, the applicant or co-applicant, acknowledge that I have:
You must complete the CAPTCHA security code below in order to successfully "Submit" your application. If you hit the "submit" button and it takes you to the top of this page, you have entered incorrect information. Please go back and review the document and look for red outlined boxes to make your changes. Be sure to hit "submit" once you have made the changes.A confirmation email will be sent to the primary email address listed on this form. If you did not provide an email address, you will not receive an email. If you have any questions regarding your application, contact St. Croix Electric Cooperative at 715-796-7000, Monday through Friday, 7:30 a.m. to 4:30 p.m. Thank you.
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