Authorization to Release Account Information

Dear Member:

The attached form will need to be filled out and returned to our office if you would like to add a designated party who may inquire about your account information.

This person will only be able to inquire about the account and make payments on your behalf. We will not be able to accept any changes to the account that the designated party may want to make on your behalf, such as a connection or disconnection, mailing address change, etc. Those changes will need to be made by you, the member.

The designated party is not responsible for any balance on the account; this person is only able to inquire about the account. The person that you designate to receive this information must have the account number and name on the account when he/she makes an inquiry.

Please fill out the attached Authorization to Release Account Information form completely and return it to our office. Upon receipt of the completed form, we will make the appropriate updates to your account. Please remember, this authorization will remain in effect until it is withdrawn in writing and delivered to Jasper County REMC.

If you have any questions or concerns, please feel free to call our office between 7:30 am and 4 pm CST, Monday through Friday at (219) 866-4601 or toll free at (888) 866-7362. You may also email us.

Sincerely,
Jasper County REMC

Authorization to Release Account Information Form

The undersigned, a member of Jasper County Rural Electric Membership Corporation (the REMC), hereby authorizes the REMC to release account information to the person or persons identified below and further authorizes the REMC to receive on the member’s behalf payments from such person or persons.