Membership Form

 

Use this form to renew or cancel your membership.  For changes to your membership such as adding new services, changing locations, or other service-related changes, please complete a form for updating your service information.  Click here for a print-friendly version of this form.

 

Renew my membership

Cancel my membership

 

If canceling your membership, please tell us why:

CONTACT INFORMATION


Company Name

First Name 

Last Name 

Mailing Address

City, State, Zip         County 

Daytime Phone Number (xxx-xxx-xxxx) 

Evening Phone Number (xxx-xxx-xxxx) 

Email Address 

 

Help us reduce mailing costs and paper usage!  Choose to receive your confirmation, renewal notices, and

newsletters by email.  We do not share email addresses with others. 

 

ANNUAL MEMBERSHIP DUES


Membership type & dues:

$15 - Households

Any residential household or residential consumer of energy in PA.

$30 -Organizations

Any cooperative organization, credit union, unincorporated association, community association, or nonprofit organization located within PA.

$30 - Businesses

Any businesses or for-profits enterprises (including landlords), located in PA.

Please note, The Co-op is still absolutely committed to providing memberships free of charge without requiring proof of income or setting specific income limits.  If you are in a low-income household or have a very small operating budget, please select your appropriate membership type from above and "Dues waiver" under payment method below. All members, whether paying or receiving a dues waiver, are required to renew their membership annually.

 

Contributions*

Help us continue offering dues waivers to members in need! 

Give an additional:

$15

$30

$45

Other amount

 

*Please note, because we are a member-owned cooperative and not a 501(c)3, contributions made to The Energy Cooperative are not considered tax-deductible charitable contributions.

 

Payment method:

Pay online now using a credit card (MasterCard, VISA, Discover)

Note: After you hit the "Submit" button below, you will be directed to a thank you page where you must click on "Pay Online Now" to connect to Click & Pledge, our secure online vendor.

Pay by check

Make check payable to The Energy Cooperative, include Membership Renewal in the memo, and mail to: The Energy Cooperative, 1528 Walnut Street, Suite 2100, Philadelphia, PA  19102

Dues waiver

      Any member in a low-income household or with a very small operating budget may request an annual dues   

      waiver. No proof of income or operating budget is required and there are no specific limits. Please use your

      own discretion to determine whether you would like to request your dues be waived this year.

N/A (Updating or canceling membership only)

PROGRAM PARTICIPATION INFORMATION


Choose all that apply:

Heating Oil Program

Electricity Program

TELL US WHAT YOU THINK!


My reasons for being a member of The Energy Cooperative (choose all that apply):

Additional Comments or Feedback

 

Please review your information above and then click submit below. (It may take a few minutes for the confirmation page to come up.  Please only hit this button once.)

 

Cancel and Return to Homepage