Landlord Agreement Request(Secure Form)

Landlord Information

Member's Account Number:*
Landlord's Member Number:*

As landlord (owner, manager, or rental agent) for rental units described below, I request that Blue Ridge Electric Membership Corporation (the cooperative) provide electric service on a continual basis to rental units not occupied by tenants.
will be responsible for and will pay for electric service to unoccupied rental units until service is placed in new tenant's name. Meters that are disconnected for non-pay will not be subject to auto reconnect.

Bills for electric service are to be addressed as follows:

Landlord's First Name:*
Landlord's Last Name:*
Mailing Address:*
State:* Zip:*
Daytime Phone: *
- -
Name of contact if different from above:
Contact First Name:
Contact Last Name:
Contact Email:
It is understood that the landlord will be bound by the provisions of the Bylaws and Service Rules and Regulations now in effect and as may from time to time be adopted by the cooperative. (Copies are available upon request or online at It is also understood that the landlord account listed below must maintain the most favorable credit rating to continue to be automatically reconnected. Either party may cancel this agreement upon fifteen (15) days written notice to the other party.
Add Or DeleteService Address Meter NumberAccount Number
The cooperative will not automatically add or delete services to the existing agreement. Please inform our office of any changes in management or ownership.