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Individual Service Agreement Form

If you have not contacted our office, please call  (812) 358-4458 to proceed with the process. 

Individual Service Agreement Form

The undersigned Member, or applicant for membership, hereby requests electric or also broadband internet service at the above location and agrees to be responsible for all billings accurately rendered for goods and services received. In addition, if not already a Member of Jackson County Rural Electric Membership Corporation (hereinafter called Cooperative), the applicant hereby applies for membership (herein called Member), the Terms and Conditions of Services Agreement, Acceptable Use Policy, and any other Rules and Regulations.
Member agrees:

1. To comply with and be bound by the Articles of Incorporation of the Cooperative, the Bylaws of the Cooperative and any amendments thereto, and such Rules and Regulations and policies as may be adopted or amended from time to time by the Cooperative, which are incorporated into this agreement by reference.
2. That all electric or also broadband internet service obtained from the Cooperative will be paid in accordance with approved Tariffs of the Cooperative and any line extension contracts in effect.
3. That all equipment installed to provide electric service or also broadband internet remains the property of the Cooperative. The member is responsible for damage to any Cooperative facilities and equipment installed at the service location.
4. To make payment of a refundable membership fee, in accordance with the Bylaws of the Cooperative, which shall be non-interest bearing and which shall be refunded as a credit against any outstanding service billings upon termination of membership; and to make payment of such other fees and deposits incidental to providing electric service as are stipulated in the Rules and Regulations, Policies, and approved Tariffs of the Cooperative.
5. If a payment does not convert to usable funds, e.g., a returned paper or electronic check, the standard fee will be assessed to the account. If this results in the electric or also broadband internet account being eligible for disconnect, the account(s) will be a disconnected per the Cooperative Bylaws, Rules and Regulations, and approved policies.
6. In the event of default in payment, reasonable collection agency fees shall be added to the amount due on the electric or also broadband internet account, plus any reasonable attorney fees and applicable court costs.
7. As a cooperative, it is expressly understood that amounts paid for electric service or also broadband internet service in excess of the costs of service are furnished by the Member as capital and the Member shall be credited with capital so furnished as provided in the Bylaws of the Cooperative.
8. Members assume no personal liability or responsibility for any debts or liabilities of the Cooperative and it is expressly understood that under law a Member’s private property cannot be attached for any such debts or liabilities.
9. An annual subscription for the Cooperative monthly newsletter shall be deducted from funds accruing in favor of the Member to reduce such funds in the same manner as would any other expense of the Cooperative.
10. Provisions of this agreement shall continue in force until Member no longer receives electric service from the Cooperative.
11. If broadband internet service is installed, it is your responsibility to take appropriate precautions to secure your own network by installing and maintaining anti-virus and anti-malware software. Jackson County REMC does not assume any responsibility and you are solely responsible for any content stored, accessed, or transmitted using Jackson County REMC broadband internet services.

12. Member authorizes the Cooperative to contact them by automated phone call, text message, or email to notify Member regarding outage information, a past due bill, pending service disconnection and/or other important information. The Member understands this authorization can be revoked by any reasonable means at any time. The Member understands any voice, text, or data costs incurred is their responsibility, and agrees to notify the Cooperative immediately in the event they voluntarily or involuntarily relinquish any of the phone numbers or contact information provided. Member acknowledges that notifications may or may not be received for a variety of reasons with no guarantee timely notifications will be received. Member further acknowledges whether or not notifications are received to hold Cooperative harmless from any liability for injuries, damages, or costs that might result from failure to receive notifications.
(As a Member, if you do not want to receive the above-named notifications, please contact the office to have your name removed. This in no way affects your ability to become a Member of the Cooperative and purchase electricity or also residential broadband Internet service.)
13. Any work on the electrical system should only be performed by knowledgeable individuals employing proper safety measures. If a remote disconnect meter is installed, an automatic remote disconnection of service, by request or for failure to keep an account in good standing, does NOT create a safe condition for work on the electrical system. Equipment failure or automatic service reconnections could result in dangerous voltages being present. 

The Member assumes full responsibility, holds harmless, and indemnifies the Cooperative from any liability for any consequences, including personal injury, death, or property damage, stemming from actions the member may undertake or cause to be undertaken, or from failure on the part of the member to make timely purchases of electricity in order to maintain uninterrupted electrical or also residential broadband Internet service.
Signatures:

  1. Any work on the electrical system should only be performed by knowledgeable individuals employing proper safety measures. If a remote disconnect meter is installed, an automatic remote disconnection of service, by request or for failure to keep an account in good standing, does NOT create a safe condition for work on the electrical system. Equipment failure or automatic service reconnections could result in dangerous voltages being present.

Signatures

Member Name- Printed
Member Name- Printed
First
Last
Spouse Name- Printed
Spouse Name- Printed
First
Last

Maximum file size: 33.55MB

Maximum file size: 33.55MB