Application for EnergyWise Electric Heat
Service availability monthly charge is $43.50
General Service rate is $ .118 (summer June-August rate is $ .132)
This Agreement made and executed the ______ day of __________________________________, 2015 by Arrowhead
Cooperative, (AC) and ____________________________________________________________________ .
(Please PRINT Member’s name)
This page must be FULLY COMPLETED PRIOR to any ENERGYWISE heat meter or subtract meter BEING ENERGIZED
Member agrees to participate in the following TWO Meter Dual Fuel-Interruptible Program. (choose only one)

# 4 Dual Fuel-Interruptible Heat @ $.060/kwh: The Member’s secondary heating system must be
sized properly to deliver heat to the entire premise. AC may control heat up to12 hours during peak and up
to 400 hours per season. Secondary heat system must have an automatic thermostat control.

# 5 Dual Fuel-Interruptible Heat & Water @ $.060/kwh: Same as Dual Fuel- Interruptible Heat
as listed above and the water heater(s) must comply with AC rules (typical 80 gal. minimum) water is
controlled 16 hrs every day (charging only 8 hours in a 24 hr period).
Interruptible back-up heat is _____________________________________________________________
(fuel oil or propane fireplace/boiler/furnace, pellet stoves, storage heaters located to prevent freezing pipes)
Rates subject to change based on latest applicable rate schedule and may be adjusted or
discontinued at any time without notice.
Note: Your secondary space heating system must be capable of providing your entire home’s heating
requirements during ON-peak period(s). Please remember that all households have differing heating and hot
water needs, so you must size your heating system and water heater according to those needs.
I, the undersigned Member, hereby certify to AC that the present Dual Fuel-Interruptible heating
system is sized properly for the entire heating load of the electric service at the following
address:___________________________________________________. I further agree that if that Dual FuelInterruptible heating system does not provide enough heat to heat my home during the on-peak
portion of the day, AC shall not be liable for any economic loss, personal injury, or property loss
that results. I further agree that AC shall not be liable for any economic loss, personal injury, or
property loss that results due to the unsatisfactory operation, malfunction, or inadequate
capacity of the heating
system.
Return agreement with hook-up fee of $200.00 for each radio receiver switch.
Failure to participate in the program for a minimum of one year may preclude this service from being
eligible for other EnergyWise heating programs now or in the future. Member agrees to allow the
Cooperative to inspect the installation and operation of the radio receiver device at all reasonable hours.
By: ____________________________________________________
Date: _____________________
(Member’s Signature)
(Today’s date)
***Electrician or owner complete boxed information below***
Load:  Heat _______ kW, Model _____________________  Water Htr_____kW, _____ gals
Socket:
 100 amp socket
 200 amp socket
 400 amp socket (CT)
 other _____________ (CT)
 Pole mount
 Pedestal
Meter:
 Subtract Heat, subtracts from general service meter (electrician will install  yes or  no)
 Primary Heat, (linemen will install & connect to transformer / $150.00 connection fee)
Electrician: _______________________________________ Ph # _____________________________