JACKSON COUNTY RURAL ELECTRIC MEMBERSHIP CORPORATION Member Notification Authorization Form I hereby authorize Jackson County Rural Electric Membership Corporation (REMC) to deliver or cause to be delivered, automated or autodialed prerecorded calls, text messages, emails, and/or any other form of automated written or audible notifications to the cell phone number and/or email address identified below. I understand that such notifications may relay information regarding my REMC account(s). I understand that I can opt-out from receiving such notifications at any time. I further understand that I am not required to provide consent, directly or indirectly, as a condition of purchasing any property, goods, or services. I affirm that the information provided below is correct and that I am the responsible party for the telephone and/or email accounts listed. I understand any voice, text, or data costs incurred are my responsibility and agree to notify REMC immediately in the event that I voluntarily or involuntarily relinquish any of the phone numbers or contact information identified below. I acknowledge that notifications may or may not be received for a variety of reasons with no guarantee timely notifications will be received. I further acknowledge whether or not notifications are received to hold REMC harmless from any liability for injuries, damages, or costs that might result from failure to receive notifications. Full Name Customer Number Member Name (Please Print) Reset Sign above Member Signature Reset Sign above Date Cell Phone Number Email Address Email Address Confirm email I have chosen to opt-out from receiving such notifications as stated above: Reset Sign above Submit
