Application for Membership
       To the Board of Directors of the Peninsula Light Company, a Washington Corporation.

The undersigned hereby makes application to become a member of the Peninsula Light Company, a Washington Corporation, and does hereby subscribe and agree to pay for one membership certificate in said corporation, the membership fee being $100 which the undersigned agrees to pay in the manner and the times prescribed in the bylaws of said corporation. The undersigned makes this application after reading the bylaws of the corporation, including Article I thereof, and fully understands the terms and conditions of membership, and if admitted to membership agrees to be bound by the said terms and conditions of and by subsequent amendments to said bylaws.

Fields marked with a red asterisk * are required.

Do you own or rent the property?
*Own/Rent: Own Rent
*Account Number:
Applicant Information
*First Name:
*Last Name:
Middle Initial:
*Social Security Number:
*Date of Birth:    (MM/DD/YYYY)
Cell Phone Number:
Co-applicant Information
First Name:
Last Name:
Middle Initial:
Social Security Number:
Date of Birth:    (MM/DD/YYYY)
Cell Phone Number:
*Home Phone Number:
*E-Mail Address:
Service Address
*Service Address:
*City:
*State:
*Zip:
Mailing Address
Mailing Address:
City:
State:
Zip:

Click here to draw your signature.
Applicant's Signature
With your mouse, draw your signature. Then click Finish.


Date: (MM/DD/YYYY)

Click here to draw your signature.
Co-applicant's Signature
With your mouse, draw your signature. Then click Finish.


Date: (MM/DD/YYYY)





Uploading ...
kb   of   kb %