Dual Sign Membership Agreement




  1. The undersigned (hereinafter referred to individually and jointly as “Member”) hereby applies for membership in and agrees to purchase the following selected utility services from NineStar Connect (hereinafter referred to as the “Cooperative”) for consumption at the address and location identified below (the “Premises”): 


Electric service

Water service

Wastewater service

Communications service


Member represents and warrants that Member is owner of the Premises or has a sufficient leasehold interest therein entitling Member to the use and occupation thereof, and acceptance of this application by the Cooperative shall bind the Member to the matters described herein and constitute a contract between the Member and the Cooperative.


  1. Member hereby acknowledges that Member will not be considered a member of the Cooperative unless and until this application is accepted by the Cooperative. Such acceptance will be based upon Member’s eligibility in accordance with the Governing Documents (as defined herein). Member acknowledges and understands that Member may not be eligible to receive all utility services selected above and that the availability of such services is dependent upon the location of the Premises within the Cooperative’s various utility service territories. Once accepted as a member of the Cooperative, Member shall be entitled to one (1) vote on the business affairs of the Cooperative on which members are permitted or required to vote regardless of the number or type of utility services received from the Cooperative and regardless of how many locations to which Member receives utility services from the Cooperative.


  1. Member hereby acknowledges that prior to agreeing to these Terms and Conditions, Member has received and has been given the opportunity to inspect and to read, in their entirety, the Articles of Incorporation, Bylaws, Operating Policies and Rules and Regulations of the Cooperative (“Governing Documents”), and Member expressly agrees, upon acceptance of this application by the Cooperative, to comply with and be bound by the rights, obligations and liabilities in the Governing Documents, and any amendments thereto, as may be adopted from time to time by the Cooperative. If Member selects to receive communications service from the Cooperative, Member must also execute a separate Subscriber Agreement prior to receiving such service or becoming a member of the Cooperative, if such membership is based solely on the receipt of communications service. If communications service is selected above, the Cooperative will not approve this application until Member has executed a Subscriber Agreement.


  1. Member agrees to purchase and pay for all utility services selected above and any other utility services selected by Member in the future and to pay all other fees and charges incidental to such utility services as approved by the Cooperative and/or the Indiana Utility Regulatory Commission in accordance with the Governing Documents. In the event it is necessary for Cooperative to refer Member’s account to an attorney or collection agency for collection, Member shall be liable for attorney’s fees and reasonable costs of collection.


  1. Member hereby agrees, when reasonably requested by the Cooperative, to grant, at no cost to the Cooperative, any license, easement or right of way as necessary for the Cooperative to construct, operate, maintain, replace or enlarge utility facilities, overhead or underground, including, but not limited to, all conduit, pipe, cables, wires, surface testing terminals, markers and other appurtenances under, through, across and upon any real property or interest therein owned, leased or controlled by Member for the furnishing of utility service to Member or to any other member of the Cooperative,. Member agrees to execute any such license, easement or right of way grant on a form to be furnished by the Cooperative.


  1. Member agrees that he, she or it shall be liable for all charges for services and incidental charges related to the services provided at the Premises so long as the account associated with the Premises remains in the name of Member, whether or not Member actually occupies the Premises. In the event that Member has a tenant occupying the Premises, Member will remain liable on the account for the Premises unless the account name is changed in writing. Thereafter, the Member will cease to be a member of the Cooperative with respect to the Premises, and the new occupant of the Premises whose name is on the associated account must complete this application and be accepted into the membership of the Cooperative.


  1. Member understands that the Cooperative does not guarantee uninterrupted utility service and is not liable for any loss, costs or damage incurred by Member related to the interruption of any utility service.


  1. Member agrees to receive relevant information regarding Member’s utility service, including outages and billing matters, through the contact telephone number (wireless or wireline) provided below using automated calls and messages. If at any time Member wishes to revoke the agreement to receive information by automated calls and messages or if Member wishes to change the contact telephone number provided, Member must notify the Cooperative in writing. The Cooperative is not liable for any loss, costs or damage incurred by Member resulting from Member’s election not to receive service-related information as provided under this section. Member will at all times remain liable for charges incurred for services even if Member elects not to receive service-related information as provided under this section.


  2. By checking the box below and submitting this application electronically to the Cooperative, Member agrees that such acts shall have the legal effect of a signature and consents to contract electronically for membership in the Cooperative and for the purchase of the utility services selected above from the Cooperative for consumption at the Premises.




Social Security No:


Contact Phone (for service-related information): 



Joint Member (if applicable)

Joint Member Name:

Joint Member Social Security No:

Joint Member Employer:

- I agree that checking this box will serve as my electronic signature on the application and terms and conditions set forth above, and I acknowledge that I have read and agree to the terms and conditions outlined above.

Leave this empty:

Signature arrow sign here

Signed by Eric Rees
Signed On: May 8, 2023

Signature Certificate
Document name: Dual Sign Membership Agreement
lock iconUnique Document ID: b3dd332f81005db5e6a80b07dc1e0ca9b854dad2
Timestamp Audit
May 8, 2023 4:02 pm GMTDual Sign Membership Agreement Uploaded by Eric Rees - eric@welldonemarketing.com IP
May 8, 2023 4:07 pm GMT Document owner eric@welldonemarketing.com has handed over this document to ninestarmarketing@ninestarconnect.com 2023-05-08 16:07:58 -