Name and/or Address Change Form

Name and/or Address Change Form

New Member Name, Mailing Address and Contact Information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Country

If name has changed:

These changes are applicable to electric service currently and/or previously rendered at the following service location(s):

Address
Address
City
State/Province
Zip/Postal
Address
Address
City
State/Province
Zip/Postal
Address
Address
City
State/Province
Zip/Postal

I CERTIFY THAT:

There has been no change in account responsibility or in the ownership of the capital credits or of any membership fee or meter deposit credits currently being held by Jackson County REMC. I will indemnify, defend and hold Jackson County REMC harmless against any claims that may arise related to these instructions. I understand that a copy of this document will be released to any party making a contrary claim.
I CERTIFY THAT:
Member Printed Full Name (Or Legal Representative)
Member Printed Full Name (Or Legal Representative)
First
Last
Maximum upload size: 10.49MB

CONTACT US

Local Calls: 812-358-4458
Toll-Free: 800-288-4458

OUR LOCATION

Jackson County REMC
274 E Base Rd
Brownstown, IN 47220

EQUAL OPPORTUNITY

This institution is an equal opportunity provider and employer. 

©Jackson County REMC. All Rights Reserved.