Residential Property Landlord Consent Agreement

This form will be in-force after all deposits and fees from the landlord are collected for each property listed.

Landlord Account Information

Apply these options to all properties listed below.(Required)

Option 1 (auto-transfer)

Option 2 (disconnect notification)

Billing Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone

Secondary Phone

Consent(Required)

I agree to the privacy policy.

A Residential Property Landlord Consent Agreement is a program offered by Jasper County REMC to landlords for residential properties only. This is a completely voluntary program for the landlords on our lines.

This program provides 2 services. The landlord may choose to participate in either, or both, options.

1. Auto-Transfer When a Landlord Consent Agreement is in effect on an account and a tenant requests disconnect of electricity; the service is immediately transferred into the name of the landlord without notice. The landlord will pay the electric bill until such time as the account is transferred to a new or different tenant.

2. Disconnection Notification If the landlord utilizes the Third-party Notification form provided with this document, the landlord will receive one notification from REMC if the rental property is scheduled to have the electric service disconnected for non-payment.

As the landlord, you agree to:

Pay an interest bearing deposit on each rental property electric account per REMC’s policy B-6.

Pay an additional non-refundable Landlord Program Service Fee of $100 per rental property or unit.

The landlord is responsible for all bills until the service is changed into the new tenant’s name.

The landlord must inform Jasper County REMC if the tenant moves out without notice.

The landlord will need to provide, and maintain, a current phone number and mailing information to Jasper County REMC.

If the landlord has a past due balance on an account listed on a Landlord Consent Agreement; Jasper County REMC reserves the right to cancel the Agreement on that property without notice.

In the event the premises are vacated with or without notice to the REMC or service is disconnected to the premises for any reason, Jasper County REMC is not responsible for any damages to the premises as a result of failure to deliver electric service even if notice is provided to the landlord. Landlord hereby waives any claim for damages to the premises occurring as a result of the failure to deliver electric service to the premises.

Jasper County REMC requires a completed Landlord Consent Agreement Cancellation Form or formal letter in order to cancel the Landlord Consent Agreement currently in place when the property is sold, transferred, otherwise disposed of or no longer utilized as a residential rental property.

Service will automatically roll into landlord’s name if the tenant requests disconnection of service.

Service will not automatically roll into landlord’s name upon the tenant’s disconnection for non-pay to REMC.

Service address of rental property must match current REMC records of the property.

I have read and understand the above conditions and hereby authorize Jasper County REMC to make such transfers as described above at the listed location(s) without further notice.

Member/Applicant/Customer Electronic Signature (Full Name)(Required)

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