{"id":39035,"date":"2022-12-08T17:51:37","date_gmt":"2022-12-09T00:51:37","guid":{"rendered":"https:\/\/www.ravallielectric.com\/?page_id=39035"},"modified":"2022-12-08T17:55:48","modified_gmt":"2022-12-09T00:55:48","slug":"new-membership-application","status":"publish","type":"page","link":"https:\/\/www.ravallielectric.com\/service\/electric-service\/new-service\/new-membership-application\/","title":{"rendered":"New Membership Application"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_safari gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_29' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_29'  action='\/wp-json\/wp\/v2\/pages\/39035' data-formid='29' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_29' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_29_1\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_1\"><h3 class=\"gsection_title\">Applicant Information<\/h3><\/div><fieldset id=\"field_29_46\"  class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_46\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Effective Start Date (mm\/dd\/yyyy)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_29_46' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_29_46_1_container'>\n                                            <label for='input_29_46_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <input type='number'  name='input_46[]' id='input_29_46_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_29_46_2_container'>\n                                            <label for='input_29_46_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                            <input type='number'  name='input_46[]' id='input_29_46_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_29_46_3_container'>\n                                            <label for='input_29_46_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                            <input type='number'  name='input_46[]' id='input_29_46_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_29_13\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_13\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >ADDRESS WHERE YOU WOULD LIKE TO ACTIVATE SERVICE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_29_13' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_29_13_1_container' >\n                                        <label for='input_29_13_1' id='input_29_13_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_13.1' id='input_29_13_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_29_13_2_container' >\n                                        <label for='input_29_13_2' id='input_29_13_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_13.2' id='input_29_13_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_29_13_3_container' >\n                                    <label for='input_29_13_3' id='input_29_13_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_13.3' id='input_29_13_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_29_13_4_container' >\n                                        <label for='input_29_13_4' id='input_29_13_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_13.4' id='input_29_13_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' selected='selected'>Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_29_13_5_container' >\n                                    <label for='input_29_13_5' id='input_29_13_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_13.5' id='input_29_13_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_13.6' id='input_29_13_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_29_25\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_25\"><legend class='gfield_label gform-field-label'  >Are you an owner or renter?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_29_25'>\n\t\t\t<div class='gchoice gchoice_29_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Owner'  id='choice_29_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_25_0' id='label_29_25_0' class='gform-field-label gform-field-label--type-inline'>Owner<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_29_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Renter'  id='choice_29_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_25_1' id='label_29_25_1' class='gform-field-label gform-field-label--type-inline'>Renter<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_29_3\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_3\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_29_3'>\n                            \n                            <span id='input_29_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_29_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_3.3' id='input_29_3_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_29_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_29_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_3.6' id='input_29_3_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_29_4\"  class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_4\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Date of Birth (mm\/dd\/yyyy)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_29_4' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_29_4_1_container'>\n                                            <label for='input_29_4_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <input type='number'  name='input_4[]' id='input_29_4_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_29_4_2_container'>\n                                            <label for='input_29_4_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                            <input type='number'  name='input_4[]' id='input_29_4_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_29_4_3_container'>\n                                            <label for='input_29_4_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                            <input type='number'  name='input_4[]' id='input_29_4_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_29_37\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_37\"><label class='gfield_label gform-field-label' for='input_29_37' >Social Security Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_29_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_29_6\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_6\"><label class='gfield_label gform-field-label' for='input_29_6' >Employer Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_29_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_29_7\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_7\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Employer Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_29_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_29_7_1_container' >\n                                        <label for='input_29_7_1' id='input_29_7_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_7.1' id='input_29_7_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_29_7_2_container' >\n                                        <label for='input_29_7_2' id='input_29_7_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_7.2' id='input_29_7_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_29_7_3_container' >\n                                    <label for='input_29_7_3' id='input_29_7_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_7.3' id='input_29_7_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_29_7_4_container' >\n                                        <label for='input_29_7_4' id='input_29_7_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_7.4' id='input_29_7_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' selected='selected'>Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_29_7_5_container' >\n                                    <label for='input_29_7_5' id='input_29_7_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_7.5' id='input_29_7_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_29_7_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_29_10\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_10\"><label class='gfield_label gform-field-label' for='input_29_10' >Cell Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_29_10' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_8\"  class=\"gfield gfield--type-phone field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_8\"><label class='gfield_label gform-field-label' for='input_29_8' >Work Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_29_8' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_9\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_9\"><label class='gfield_label gform-field-label' for='input_29_9' >Home Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_29_9' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_11\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_11\"><label class='gfield_label gform-field-label' for='input_29_11' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_29_11' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_29_14\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_14\"><legend class='gfield_label gform-field-label'  >Are you applying with a Co-Applicant?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_29_14'>\n\t\t\t<div class='gchoice gchoice_29_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_29_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_14_0' id='label_29_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_29_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_29_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_14_1' id='label_29_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_29_16\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_16\"><h3 class=\"gsection_title\">Co-Applicant Information<\/h3><\/div><fieldset id=\"field_29_15\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_15\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Co-Applicant Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_29_15'>\n                            \n                            <span id='input_29_15_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_29_15_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_15.3' id='input_29_15_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_29_15_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_29_15_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_15.6' id='input_29_15_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_29_17\"  class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_17\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Co-Applicant Date of Birth (mm\/dd\/yyyy)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_29_17' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_29_17_1_container'>\n                                            <label for='input_29_17_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <input type='number'  name='input_17[]' id='input_29_17_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_29_17_2_container'>\n                                            <label for='input_29_17_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                            <input type='number'  name='input_17[]' id='input_29_17_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_29_17_3_container'>\n                                            <label for='input_29_17_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                            <input type='number'  name='input_17[]' id='input_29_17_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_29_38\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_38\"><label class='gfield_label gform-field-label' for='input_29_38' >Co-Applicant Social Security Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_29_38' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_29_19\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_19\"><label class='gfield_label gform-field-label' for='input_29_19' >Co-Applicant Employer Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_29_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_29_20\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_20\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Co-Applicant Employer Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_29_20' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_29_20_1_container' >\n                                        <label for='input_29_20_1' id='input_29_20_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_20.1' id='input_29_20_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_29_20_2_container' >\n                                        <label for='input_29_20_2' id='input_29_20_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_20.2' id='input_29_20_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_29_20_3_container' >\n                                    <label for='input_29_20_3' id='input_29_20_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_20.3' id='input_29_20_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_29_20_4_container' >\n                                        <label for='input_29_20_4' id='input_29_20_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_20.4' id='input_29_20_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' selected='selected'>Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_29_20_5_container' >\n                                    <label for='input_29_20_5' id='input_29_20_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_20.5' id='input_29_20_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_20.6' id='input_29_20_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_29_21\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_21\"><label class='gfield_label gform-field-label' for='input_29_21' >Co-Applicant Cell Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_29_21' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_22\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_22\"><label class='gfield_label gform-field-label' for='input_29_22' >Co-Applicant Work Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_22' id='input_29_22' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_23\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_23\"><label class='gfield_label gform-field-label' for='input_29_23' >Co-Applicant Home Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_29_23' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_29_24\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_24\"><label class='gfield_label gform-field-label' for='input_29_24' >Co-Applicant Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_24' id='input_29_24' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_29_26\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_26\"><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_29_12\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_12\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Mailing Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_29_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_29_12_1_container' >\n                                        <label for='input_29_12_1' id='input_29_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_12.1' id='input_29_12_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_29_12_2_container' >\n                                        <label for='input_29_12_2' id='input_29_12_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_12.2' id='input_29_12_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_29_12_3_container' >\n                                    <label for='input_29_12_3' id='input_29_12_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_12.3' id='input_29_12_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_29_12_4_container' >\n                                        <label for='input_29_12_4' id='input_29_12_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_12.4' id='input_29_12_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' selected='selected'>Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_29_12_5_container' >\n                                    <label for='input_29_12_5' id='input_29_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_12.5' id='input_29_12_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_12.6' id='input_29_12_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_29_27\"  class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_27\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Landlord Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_29_27'>\n                            \n                            <span id='input_29_27_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_29_27_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_27.3' id='input_29_27_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_29_27_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_29_27_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_27.6' id='input_29_27_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_29_28\"  class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_28\"><label class='gfield_label gform-field-label' for='input_29_28' >Landlord Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_28' id='input_29_28' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_29_29\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_29\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name of nearest relative not living with you<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_29_29'>\n                            \n                            <span id='input_29_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_29_29_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_29.3' id='input_29_29_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_29_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_29_29_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_29.6' id='input_29_29_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_29_30\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_30\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address of nearest relative not living with you<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_29_30' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_29_30_1_container' >\n                                        <label for='input_29_30_1' id='input_29_30_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_30.1' id='input_29_30_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_29_30_2_container' >\n                                        <label for='input_29_30_2' id='input_29_30_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_30.2' id='input_29_30_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_29_30_3_container' >\n                                    <label for='input_29_30_3' id='input_29_30_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_30.3' id='input_29_30_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_29_30_4_container' >\n                                        <label for='input_29_30_4' id='input_29_30_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_30.4' id='input_29_30_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_29_30_5_container' >\n                                    <label for='input_29_30_5' id='input_29_30_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_30.5' id='input_29_30_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_30.6' id='input_29_30_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_29_31\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_31\"><legend class='gfield_label gform-field-label'  >Have you ever had service with Ravalli Electric Co-op before?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_29_31'>\n\t\t\t<div class='gchoice gchoice_29_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_29_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_31_0' id='label_29_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_29_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_29_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_29_31_1' id='label_29_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_29_33\"  class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_33\"><label class='gfield_label gform-field-label' for='input_29_33' >Applicant Photo ID (i.e. driver&#039;s license)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='523239424' \/><input name='input_33' id='input_29_33' type='file' class='large' aria-describedby=\"gfield_upload_rules_29_33\" onchange='javascript:gformValidateFileSize( this, 523239424 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_29_33'>Max. file size: 499 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_29_33'><\/div><\/div><\/div><div id=\"field_29_32\"  class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_32\"><label class='gfield_label gform-field-label' for='input_29_32' >Co-Applicant Photo ID<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='523239424' \/><input name='input_32' id='input_29_32' type='file' class='large' aria-describedby=\"gfield_upload_rules_29_32\" onchange='javascript:gformValidateFileSize( this, 523239424 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_29_32'>Max. file size: 499 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_29_32'><\/div><\/div><\/div><fieldset id=\"field_29_34\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_34\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_34.1' id='input_29_34_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_29_34_1' >Everything that I have stated in this application is correct to the best of my knowledge. You are authorized to check my credit and employment history and to answer questions about cooperative credit experience to me.<\/label><input type='hidden' name='input_34.2' value='Everything that I have stated in this application is correct to the best of my knowledge. You are authorized to check my credit and employment history and to answer questions about cooperative credit experience to me.' class='gform_hidden' \/><input type='hidden' name='input_34.3' value='37' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_29_45\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_45\"><h3 class=\"gsection_title\">Application for Membership\/Agreement<\/h3><\/div><fieldset id=\"field_29_40\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_40\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Application for Membership\/Agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_29_40'><span style=\"font-size: 120%;\"><p>The undersigned (hereinafter referred to as Applicant, whether singular or plural) hereby applies for membership in RAVALLI COUNTY ELECTRIC COOPERATIVE,<br \/>\nINC. [hereinafter referred to as Cooperative], and this executed application for membership, together with the credit application executed simultaneously herewith,<br \/>\nconstitute a binding agreement between the Applicant and the Cooperative following approval by Cooperative as provided in its bylaws and policies.<\/p><br \/>\n<p><strong>Applicant Hereby Agrees As Follows:<\/strong><br \/>\n<ol><br \/>\n<li>Applicant extends authority on behalf of Applicant and all owners of the Property (as defined below), the right to enter the Property for the purpose of repairing or maintaining existing power facilities, overhead or underground, and the right to clear and remove all timber, brush, and other obstructions from the right-of-way to a distance of at least ten feet on each side of the constructed line and\/or to cut and remove trees, brush, or other obstructions outside of such right-of-way which may endanger the line. Applicant agrees that Cooperative and its agents may take any reasonable safety measures to provide clearance for power lines and related facilities, including but not limited to, those required or recommended by state, federal, or industry laws or regulations.<\/li><br \/>\n<li>Applicant is responsible for Applicant\u2019s power, service, and other obligations as provided in this Agreement but, by becoming a member, assumes no other personal liability for any debts or liabilities of the Cooperative, and property of Applicant cannot be attached for the Cooperative's debts or liabilities.<\/li><br \/>\n<li>Applicant agrees that amounts in Applicant\u2019s account on the books of the Cooperative which are available for retirement pursuant to proper action of the Board, is hereby assigned, transferred and set over to the Cooperative and shall become due and payable to the Cooperative if after the required times and pursuant to the procedures set forth in the Cooperative bylaws and\/or policies and in accordance with Montana law, following a bona fide attempt to pay said amount to Applicant (whether by sending a letter to Applicant\u2019s last address or shown in the books of the Cooperative or otherwise) the Cooperative is unable to locate Applicant for the purposes of retiring capital credits. Applicant agrees to provide the Cooperative with a correct current address, even following termination of service with the Cooperative for purposes of retiring any capital credits.<\/li><br \/>\n<li>Cooperative will use reasonable efforts to furnish adequate and dependable electric service, although it cannot and, therefore, does not guaranty a continuous, uninterrupted supply of electricity and the Cooperative may limit the amount of electricity furnished to any one member. Applicant shall pay for electric energy used. Production or use of electric energy on such premises, regardless of the source thereof, by means of facilities which shall be inter-connected with the Cooperative facilities shall be subject to minimum capacities, rules, and regulations established by the Board of Trustees and appropriate safety regulations as shall be fixed from time to time by the Cooperative. It is expressly understood and agreed that amounts paid for electric energy in excess of the cost of service are furnished by members as capital, and each member shall be credited with the capital so furnished as provided by the bylaws and policies of the Cooperative. Each member shall pay to the Cooperative such minimum amount (according to the rate schedule appropriate for Applicant's type of service, regardless of the amount of electric energy consumed) as shall be fixed by the Board of Trustees from time to time.<\/li><br \/>\n<li>Applicant has paid herewith a non-refundable application fee. Applicant also agrees to deposit with Cooperative such consumer deposit as is required by the regulations and policies of the Cooperative, and the same may be applied to payment of bills due the Cooperative, with the balance being refunded to the Applicant following termination of all services to Applicant and payment of all of Applicant's outstanding obligations. Applicant understands that membership is non-transferable. Applicant shall be responsible for all bills for electric service from the time of connect until such time as Applicant notifies the Cooperative, in writing, that service is no longer required. Applicant agrees to pay all amounts owed by Applicant to the Cooperative as and when the same shall become due and payable. Applicant agrees to pay all interest charges on delinquent accounts pursuant to the policies and regulations established by the Cooperative. Applicant agrees to pay the reasonable collection charges of the Cooperative including but not limited to court costs and attorney's fees, if payments due to Cooperative are not timely made.<\/li><br \/>\n<li>Applicant acknowledges participation in the \u201cPower of Change\u201d program which will result in monthly electric bills rounded up to the nearest dollar with the extra money going into a fund for community projects. Applicant may request to opt out of the \u201cPower of Change\u201d program at any time by written request to the Cooperative.<\/li><br \/>\n<li> Applicant agrees to save harmless and indemnify the Cooperative for any expenses or liabilities for damage to any person, livestock, or other property caused by the presence of electric energy on the Property or adjacent thereto where Applicant (or persons acting under Applicant's knowledge, imputed knowledge, or authority) has constructed or placed any property adjacent to the poles, wires, or other apparatus of Cooperative. Applicant agrees not to work with, touch, handle, repair, or in any manner contact any of the poles, wires, transformers, meters, or other apparatus of the Cooperative, nor permit any other persons to do so, and will indemnify and save Cooperative harmless from all costs, damages, or expenses should violations of this provision result in any damages to persons or property.<\/li><br \/>\n<li>Applicant acknowledges and understands that members of the Cooperative are entitled to access to the Articles of Incorporation, bylaws, and all policies, rules, and regulations affecting the Cooperative. Applicant agrees to abide by the Articles of Incorporation, bylaws, policies, rules, and regulations as established and amended by the Cooperative.<\/li><br \/>\n<li>The acceptance of this application and service obligation by Cooperative shall constitute an executed agreement between Applicant and Cooperative. The Applicant understands and acknowledges that in the event the easements required to be executed by all parties holding an interest in the property are not provided to Cooperative or Applicant does not abide by any other provisions of this agreement or the rules and regulations of the Cooperative, then the Cooperative, at Cooperative's option, may cancel Applicant's membership.<\/li><br \/>\n<li>Applicant hereby affirms that all of the information in this application and the credit application files in conjunction herewith is true and correct in all matters, and in the event that any false or incorrect information is included herein, Applicant waives right to service, and Cooperative can discontinue service to the Applicant without notice upon discovering such mis-stated or false information.<\/li><br \/>\n<\/ol><\/p><br \/>\n<p><strong>The applicant(s) has\/have carefully read the above application, acknowledges(s) that Cooperative has made no promises or agreements aside from the provisions contained herein, and understand(s) that it constitutes a binding agreement when approved by cooperative as provided in its bylaws and policies.<\/strong><\/p><br \/>\n<\/span><\/div><div class='ginput_container ginput_container_consent'><input name='input_40.1' id='input_29_40_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_29_40\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_29_40_1' >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\u2019s date and authorized by me as if I had signed my signature.<\/label><input type='hidden' name='input_40.2' value='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\u2019s date and authorized by me as if I had signed my signature.' class='gform_hidden' \/><input type='hidden' name='input_40.3' value='37' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_29_35\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_35\"><label class='gfield_label gform-field-label' for='input_29_35' >Applicant Electronic Signature (Full Name)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_29_35' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_29_36\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_36\"><label class='gfield_label gform-field-label' for='input_29_36' >Co-Applicant Electronic Signature (Full Name)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_29_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_29_44\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_44\"><h3 class=\"gsection_title\">Owner&#039;s Acknowledgment<\/h3><\/div><fieldset id=\"field_29_41\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_29_41\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Owner&#039;s Acknowledgment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_29_41'><span style=\"font-size: 120%;\"><br \/>\nOwner(s) is\/are the sole owner of the Property.<br \/><br \/>\nConstruction of new extensions or services shall be in accordance with the Cooperative\u2019s policies and regulations in effect at that time.<br \/><br \/>\nThe Owner(s) agrees to execute and deliver to the Cooperative at Cooperative's request, perpetual grants of easement and\/or rights-of way on, over, or under such lands owned, leased or otherwise in the control of the Owner(s) and in accordance with the reasonable terms and conditions as the Cooperative shall require for the furnishing of electric service to the Property, and for the construction, operation, or maintenance of the Cooperative's facilities. Easements and rights of-way to be granted by Owner(s) shall include Cooperative's maintenance requirements referred to in provision 1 of the Applicant section and shall run with the land.<br \/><br \/>\nOwner(s) understands and agrees that all lines, line extensions, and other facilities and equipment installed or placed on the Property by the Cooperative shall be solely the property of the Cooperative, removable at the option of the Cooperative. Owner(s), not the Cooperative, shall be solely responsible for all lines or electrical facilities from the meter to the location of the facility served.<br \/>\n<\/span><\/div><div class='ginput_container ginput_container_consent'><input name='input_41.1' id='input_29_41_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_29_41\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_29_41_1' >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\u2019s date and authorized by me as if I had signed my signature.<\/label><input type='hidden' name='input_41.2' value='I hereby verify the information to be true and complete and agree to the terms and conditions. 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