Lending Cooperative Mutual-Aid Form

Lending Mutual-Aid Form

If your cooperative is lending mutual-aid to a distressed cooperative. Please complete the form below.

Cooperative Lending Mutual-Aid Assistance*
If your cooperative is lending mutual-aid to a distressed cooperative. Please complete the form below.
Contact's Name at the Cooperative*
First Last
Primary Contact's Phone Number*
Primary Contact's Email*
Cooperative Lending Mutual-Aid Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Radio Channel Used
Uniform Arc Rating
Gloving Voltages Crews Equipped for
Please upload the signed NRECA Mutual-Aid Agreement
Max. file size: 30 MB.
Are FEMA equipment rates used?
Please upload rates charged for man hours
If rates for man hours are not included in the Mutual-Aid Agreement, please upload.
Max. file size: 30 MB.
Please upload rates for equipment
If rates for equipment are different from FEMA rates or they are not included in the Mutual-Aid Agreement, please upload.
Max. file size: 30 MB.
Date crews are available*
MM slash DD slash YYYY
Number of days crews are available*
Are rotation crews available?*
Crew 1
Type of Crew*
Ranking person on the crew*
First Last
Phone number for the ranking person on the crew*
Additional Crew Members*
Please use the plus sign to add additional people.
Crew Member's Name Job Classification Cell Phone Number Vehicle Type Vehicle Number(s) Emergency Contact Emergency Phone Number
Special equipment en route with crew?
Description of specialty equipment
Crew 2
Only complete Crews 2-4 if you are sending multiple crews.
Type of Crew*
Ranking person on the crew*
First Last
Phone number for the ranking person on the crew*
Additional Crew Members*
Please use the plus sign to add additional people.
Crew Member's Name Job Classification Cell Hone Number Vehicle Type Vehicle Number(s) Emergency Contact Emergency Phone Number
Special equipment en route with crew?
Description of specialty equipment
Crew 3
Type of Crew*
Ranking person on the crew*
First Last
Phone number for the ranking person on the crew*
Additional Crew Members*
Please use the plus sign to add additional people.
Crew Member's Name Job Classification Cell Hone Number Vehicle Type Vehicle Number(s) Emergency Contact Emergency Phone Number
Special equipment en route with crew?
Description of specialty equipment
Crew 4
Type of Crew*
Ranking person on the crew*
First Last
Phone number for the ranking person on the crew*
Additional Crew Members*
Please use the plus sign to add additional people.
Crew Member's Name Job Classification Cell Hone Number Vehicle Type Vehicle Number(s) Emergency Contact Emergency Phone Number
Special equipment en route with crew?
Description of specialty equipment

Crew Member's Name	Job Classification	Cell Phone Number	Vehicle Type	Vehicle Number(s)	Emergency Contact	Emergency Phone Number

Crew Member's Name	Job Classification	Cell Hone Number	Vehicle Type	Vehicle Number(s)	Emergency Contact	Emergency Phone Number

Lending Mutual-Aid Form

Crew 1

Crew 2

Crew 3

Crew 4