Individual Service Agreement Form

Individual Service Agreement Form
The undersigned Member, or applicant for membership, hereby requests electric 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 which are applicable to all service locations.

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 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 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 account being eligible for disconnect, the account 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 account, plus any reasonable attorney fees and applicable court costs.
  7. As a cooperative, it is expressly understood that amounts paid for electric 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. 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.
  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.


Member Name- Printed
Member Name- Printed
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Jackson County REMC
274 E Base Rd
Brownstown, IN 47220


This institution is an equal opportunity provider and employer. 

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