New members must fill out a membership application before completing this form. Name(s) on AccountName(Required) First Last Name First Last Account Number Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Phone(Required)Text:(Required) Yes No Secondary PhoneText: Yes No Email(Required) I, the above-named member, hereby voluntarily apply to participate in Prepaid Electric Service offered to members of Jasper County REMC (“REMC”), and I accept and agree to comply with all terms and conditions contained in this agreement. I understand and agree that the eligibility criteria, enrollment process, and operating procedures for the voluntary Prepaid Program are set forth in the Terms and Conditions, which are attached hereto and incorporated herein and which may be amended from time to time in the sole discretion of the REMC. Payment Arrangement: I acknowledge and agree that I currently have an outstanding balance of...that I owe to REMC. I acknowledge and agree that I must pay...of this balance before beginning the Prepaid Electric Service program, and I have chosen to make a payment arrangement with REMC pursuant to Section 3 of the Terms and Conditions of the Prepaid Electric Service program to pay the remainder of the outstanding balance, which is...Outstanding Balance(Required)Payment Amount(Required)Outstanding Balance Remainder(Required)Initial(Required) Notifications: I understand and agree that it is my responsibility to monitor my electric use and make sure I maintain a positive credit balance and that failure to do so will result in disconnection of my Electric Service. In order for me to receive the necessary system alerts to avoid disconnection of service, I agree to provide the REMC with current phone numbers and/or email address and utilize the SmartHub monitoring tools. REMC will provide low balance and disconnect notifications through SmartHub, but does not guarantee that all notifications or messaging will reach me prior to disconnection. I understand and agree that I will register in SmartHub to have Prepaid notifications sent to me by text message, push notification or email. The REMC will send notification through SmartHub of low balance every day that my Prepaid account balance has an estimated 5 days of Electric Service left. Initial(Required) No Medical or Health Exceptions: I understand and agree that the medical and health conditions of any person located at the address where electric service is furnished and/or inclement weather conditions or temperatures will not postpone disconnection of electric service. Initial(Required) Disconnection: I understand and agree that my Prepaid Electric Service account is subject to a disconnection of electric service at approximately 1 p.m. Central Time each day of the year when my credit balance falls below $0. I understand and agree that I will not receive any advance notice of disconnection from the Utility other than the “5-day low balance” notification described above, and I hereby waive all rights to any other advance notice of disconnection. I understand and agree that my Prepaid Electric Service account will not be reconnected until my balance is brought up to a credit of $25. I understand and agree that any returned checks or other fees will be debited or charged against my account immediately. I understand and agree that if this causes the credit balance to be exhausted, my electric service will be disconnected. I understand and agree that once a check has been returned on my Prepaid account, Jasper County REMC will no longer accept checks for payment on my account. Initial(Required) Reconnection after final billing: I understand and agree that if my account is disconnected for more than 7 days, my Prepay account will be closed and a final bill will be issued. I understand and agree that if I request reconnection after the final bill has been issued, I must pay the REMC’s standard Reconnect Charge, the Prepaid minimum balance, and the full outstanding balance on my account before power is restored, and I hereby waive all rights to continue any payment arrangement that was previously offered by the REMC. Initial(Required) Agreement to Terms and Conditions(Required) Effective as of June 25, 2020 These Terms and Conditions establish the eligibility criteria, enrollment process, and operating procedures for the voluntary Prepaid Electric Service Program. The REMC reserves the right to amend these Terms and Conditions at any time and in its sole discretion. Eligibility: Prepaid Electric Service is only available to single phase, non demand with remote disconnect/connect capability accounts including those with Jasper County REMC provided dusk to-dawn lighting. Prepaid Electric Service is not available to accounts on Bank Draft, Budget Billing, or that have other payment arrangements. Prepaid Electric Service is only available to members who execute the Agreement for Prepaid Electric Service and who are capable of and willing to use the SmartHub monitoring tools online or through the SmartHub app. New Members: New members requesting Prepaid Electric Service must complete a membership application. A minimum payment of $25.00 for electric use is required for initial Prepaid Electric Service. No deposit is required unless the member converts from a Prepaid Electric Service account to another kind of payment account at a later date. All applicable credit checks and deposits, if necessary, will apply at that time. Existing Members: Existing members opting to convert their account to a Prepaid Electric Service account must comply with one of the following options: Pay in full all pre-existing fees, current account balances and unbilled electric use, or Make a payment arrangement of up to $250 of total balance due, of which 30% of all future Prepaid payments will be applied to the existing balance until the existing balance is paid in full. The member may pay off the existing balance at any time. Any balance above $250 at time of signing up for Prepaid Electric Service must be paid in full at the time of sign-up. Members may choose to have existing deposits applied (when applicable) to account balances and/or their Prepaid Electric Service account, with the understanding that if the member wishes to convert from Prepaid Electric Service back to a traditional payment account, all applicable credit checks and deposits will apply and any outstanding debt must be paid in full at that time. An account must have at least $25 credit to begin Prepaid billing. Rates, Charges, Billing, and Payments: Prepaid Electric Service accounts will be charged all current applicable rates, energy tracker adjustments and distribution facilities charges. Prepaid Electric Service account charges will be calculated and debited or charged against the account daily up to final billing. These charges will include electric use as well as other applicable charges and fees, including payment arrangements, energy tracker adjustments and a distribution facilities charge. Prepaid Electric Service accounts will not receive a monthly bill in the mail although it will be available to view through SmartHub. Members will have 24-hour access to usage information online through SmartHub and on the SmartHub app. Customer Service Representatives will also be able to provide this information during regular business hours. Payments can be made 24 hours a day via credit card, debit card or e-check at (844) 736-2729, online through SmartHub or on the SmartHub app. Payments can be made at Jasper County REMC’s office location during regular business hours. Minimum payment by any method is $5. I have read, understand, and accept the terms and conditions of Prepaid Electric Service set forth in this Agreement. I also agree to abide by Jasper County REMC’s bylaws, policies, and rules and regulations as may be approved or amended from time to time by the Board of Directors. By signing below, I am waiving all claims or action against Jasper County REMC arising out of or relating to any interruption in service or disconnection due to a balance that falls below $0. I hereby waive any right to receive advance notice of disconnection that would apply under a traditional payment account. I agree that the REMC will not be held responsible for any direct or indirect damage to property or injury to persons (including death) arising out of or relating to any failure to make a timely payment to maintain a credit balance on my account or any action taken by the REMC to disconnect my service after my account balance falls below $0. This agreement is intended to completely release the REMC from any damages related to service interruptions and disconnections of Prepaid Electric Service. I agree to the terms and conditions.Initial(Required) For new Members: I understand and agree this form must be completed and returned to the REMC office with any required beginning balance before service will be connected at the property. For existing Members: I understand and agree this form must be completed and returned to the REMC office with any required beginning balance before the Prepaid program will begin on the account.Member Electronic Signature (Full Name)(Required) PhoneThis field is for validation purposes and should be left unchanged.
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