Landlord/Property Manager(Required) First Last Landlord Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Service Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Consent(Required) This agreement is between the Landlord/Property Manager and Kotzebue Electric Association, Inc. KEA will attempt but not guarantee that electrical service and billing will be continued under the Landlord/Property Manager's name from the time of a disconnect by one Tenant until a succeeding Tenant applies for service, or the Landlord/Property Manager discontinues service in writing. It is the Landlord/Property Managers responsibility to notify KEA of any changes in tenant status. This arrangement will not prevent a disconnection for non-payment if the assuming party (Landlord/Property Manager) does not assume responsibility for the tenants past due account for electric service. Where the Tenant is the customer of the Association and is subject to disconnection, the Association shall attempt to notify the Landlord/Property Manager of the option of subscribing for the service. If the Landlord/Property Manager declines to subscribe for service, the Association may disconnect service without further notice. The Landlord/Property Manager may terminate this Agreement by written notice at any time. The Landlord/Property Manager agrees to assume responsibility for payment of bills during the periods when no tenant has properly applied for electric service, and further agrees to assume responsibility for advising the Tenant that an application for membership and a deposit with the Association is required. It is the responsibility of the Landlord/Property Manager to immediately notify KEA when there is any change in the status of the property listed with this agreement, not doing so would nullify this agreement. It is also the responsibility of the Landlord/Property Manager to ensure that the association has a current phone number and address of the Landlord/Property Manager. The Association assumes no liability or obligation other than those stated in this agreement or Rules and Regulations in the KEA Tariffs. KEA reserves the right to cancel this agreement and apply any deposits to monies due the Association. I hereby verify the information to be true and complete and agree to the terms of the Agreement. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signatureLandlord/Property Manager Electronic Signature (Full Name)(Required) PhoneThis field is for validation purposes and should be left unchanged.
