Application Date: Thursday, April 24, 2014 Application Type: Organization Organization Type:
Organization Name: * Organization Contact Information First Name: * Last Name: * Address: * Address (cont): City: * State:
District of Columbia
Zip Code: * Email: * Home Phone: Work Phone: * Cell Phone: Payment Information Payment Method:
Make checks payable to HOURCAR / NEC. Mail your check or money order along with your completed application to: HOURCAR Membership Neighborhood Energy Connection 624 Selby Avenue Saint Paul, MN 55104 Promotions
Name of referring member: Referrals and Promotions How did you find us? *
At an Event
From a Friend
Heard about you on the Current
In the Minnesota Daily
In the News
I saw an Ad
I saw an ad at a bus stop
I saw an ad on a bus
I saw an HOURCAR
* Please provide specific details if you can: Did a member refer you? Who? Verification By submitting your application to HOURCAR, you
Verify that everything stated in the application is true.
Authorize HOURCAR, its agents, and insurers to review your credit history, driving record, criminal record, and other background information as HOURCAR shall deem relevant to its approval of Member's participation in the HOURCAR program.
Understand that the information provided by you and the review of your driving record will be retained by HOURCAR and its agents and insurers, whether or not your application is approved.
I understand and accept