Application for Operation of
Customer-owned Generation System
Under Cooperative's Net Metering Program

This application (the "Application") should be completed as soon as possible and returned to the
Cooperative at the address listed below in order to begin processing this request. Additional
information provided to the Applicant includes the Cooperative's General Description of the
Net Metering Program, Net Metering Tariff Schedule M,
and Agreement for Interconnection and Parallel
Operation of Customer-owned Generation System with Cooperative's distribution system under
Cooperative's Net Metering Program.
 
INFORMATION: This Application is used by the Cooperative to determine the required equipment
configuration and special studies (if any) for the Net Metering Customer interface. Every effort should be
made to supply as much information as possible.
**All Fields Required**
OWNER/APPLICANT INFORMATION
Legal Name of Owner/Applicant:
Mailing Address:
City: County: State: Zip Code:
Phone Number: Representitive (if Company):
Applicant's Electric Service Account Number:
Name/Address of the Applicant as it appears on the Applicant's electric bill:
Name:
Address:
PROJECT DESIGN/CONSULTING ENGINEER (ARCHITECT/ENGINEER) (as applicable)
Company:
Mailing Address:
City: County: State: Zip Code:
Phone Number: Representitive:
ELECTRICAL CONTRACTOR(as applicable)
Company:
Mailing Address:
City: County: State: Zip Code:
Phone Number: Representitive:
PROVIDE PLANNED DATES AS FOLLOWS
Installation Period From: To:
Testing:
Start Up:
Full Operation:
GENERAL INFORMATION
Generator Rating: (kW) Annual Estimated Generation: (kWh)
Manufacturer: Model: Version:
TYPE OF PRIME MOVER(mark as applicable)


MODE OF OPERATION
Interconnection Voltage: Voltage:
INVERTER DATA
Manufacturer: Model:
Rated Power Factor(%): Rated Voltage(Volts): Rated Amperes:
Inverter Type (ferroresonant, step, pulse-width modulation, etc):
Approval/Testing Laboratory:
Type commutation:
Harmonic Distortion: Maximum Single Harmonic (%)
Maximum Total Harmonic (%)
DESCRIPTION OD PROPOSED INSTALLATION AND OPERATION
Give a general description of the proposed installation. Include a detailed description of its planned location if
different than address on electric bill when you plan to operate the generator and how it will be interconnected to
your facilities.
ADDITIONAL INFORMATION REQUIRED
In addition to the items listed above, please attach a detailed one-line electrical diagram of the proposed
facility, all applicable diagrams, major equipment, specifications, test reports, etc., and any other
available drawings or documents necessary for the proper review and design of the interconnection.
Please attach copies of product literature about the equipment you are planning to install.

Attach Files?(please place all files for upload into a single zip file)
SIGNATURE
The Owner/Applicant agrees to provide the Cooperative with any additional information required to
complete the interconnection. The Owner/Applicant shall operate equipment within the guidelines set
forth by the Cooperative. Note that this application and other information below may become Exhibits in
the Agreement for Interconnection and Parallel Operation of Customer-owned Generation System under
Cooperative's Net Metering Program.
That Agreement is required for Interconnection.

The Owner/Applicant certifies that all information provided in this Application is true and accurate.
Owner/Applicant Date 7/19/2018