SURGE GUARD PARTICIPATION AGREEMENT

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SURGE GUARD PARTICIPATION AGREEMENT Powered By Docstoc
					           Pee Dee Electric Cooperative, Inc.


                    SURGE GUARD® PARTICIPATION AGREEMENT
                                                              ®
I wish to participate in Pee Dee Electric’s SURGE GUARD Program. I understand the following:
Pee Dee Electric Cooperative will allow me to use surge protection at this service address:

Street_______________________________________                                    Pole # _____________________

City _____________________________________, SC                                   Map # _____________________

ZIP ___________________                                                          Meter # ____________________


Pee Dee Electric will provide and install the meter base device. The meter base device manufacturer makes
warranties covering the device and my use of it. PEE DEE ELECTRIC COOPERATIVE MAKES NO
WARRANTIES, expressed or implied. A copy of the manufacturer’s extended 10-year warranty will be provided.
There will be a $35 installation fee which will be billed to my account at the time of installation.

I agree to pay Five Dollars ($5.00) per month for use of the meter base device. I authorize this amount to be added
to my monthly electric bill and be part of the total due Pee Dee Electric Cooperative every month.

Either Pee Dee Electric or I may discontinue participation in the program at any time. An exit fee will apply should I
discontinue participation before 24 months elapse. I will notify Pee Dee Electric Cooperative if I no longer want to
participate. Pee Dee Electric will notify me if the program is discontinued or if at its option this agreement is
canceled.

If I use the meter base device for one hundred twenty (120) consecutive months, it becomes mine. If I have made
all payments, I will not have to pay anything more for the equipment.

Acct. # ________________________________ Installation Fee: Amount $________ Paid Charged (Circle)

Name _______________________________________                              Home Phone _____________________

Address _____________________________________                             Work Phone _____________________

City _____________________________________, SC

ZIP ___________________

Signature ____________________________________

Date __________________


For Office Use Only
PDEC Rep. ___________________________________________________ Date ____________________

Installed By ___________________________________________________ Date ____________________

Serial # _______________________________ Mfg. Date ______________ Warranty_________________

White - Member                                     Yellow - Marketing                                  Mkting Rev 10/04