Name(Required) First Last Property Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Consent(Required)Ravalli Electric Co-op, Inc. will provide our landlord (property owner) members with the option to enter into an agreement whereby disconnections of service at rental facilities will create an automatic transfer of service from the tenant's name to the landlord's name. This agreement will enable the landlord to avoid a $10 processing fee in the event the tenant moves out and the owner would like the service back in their name. Ravalli Electric Co-op, Inc. will not notify the Landlord in the event of disconnection by request of the tenant. Service will continue and be transferred into the Landlord's name. In the event of a non requested disconnection, (disconnect for non-payment) the Landlord will be notified and given the option to pay the charges and have service transferred to their name or to prepare the home for disconnection (winterize). Service may not be transferred out of the tenant's name to avoid tenant paying the balance due. The Cooperative is not obligated to perform under this agreement in the event the tenant moves without notification to the Cooperative of such intentions. Electricity cannot be terminated by the landlord if such service is still in the tenant's name. Sale of the property or any other change of ownership should be communicated to the Co-op in writing. Ravalli Electric Co-op's Terms and Conditions of Service supersede any and all other agreements between the tenant, landlord and Ravalli Electric Co-op, Inc. I, as the Landlord (property owner) do hereby request that the property located at the address listed above be automatically transferred into my name upon the request for disconnection. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Landlord Electronic Signature (Full Name)(Required) CommentsThis field is for validation purposes and should be left unchanged.