Fillable SERVICE APPLICATION FORM (Appalachian Electric Cooperative)

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SERVICE APPLICATION FORM (Appalachian Electric Cooperative)

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SERVICE APPLICATION FORM
FLEX PAY ACCOUNT
POST PAY ACCOUNT
$
SERVICE ADDRESS
DATE SERVICE REQUESTED
EMAIL ADDRESS
FIRST NAME
MIDDLE INITIAL
LAST NAME
Mailing Address
SOCIAL SECURITY NUMBER
DL NUMBER & STATE
DOB
EMPLOYER NAME
ADDRESS
SPOUSE’S NAME
PHONE NUMBER
SOCIAL SECURITY NUMBER
DL NUMBER & STATE
DOB
EMPLOYER NAME
ADDRESS
CERTIFICATE OF MEMBERSHIP
I, ___________________________, (hereinafter called "applicant") hereby apply for membership in and agree to purchase electric energy from APPALACHIAN ELECTRIC
COOPERATIVE, Jefferson City, Tennessee, (hereinafter call "Cooperative") to be supplied at any address served by said Cooperative.
1. The applicant agrees to pay for said services as bills are rendered therefore, in accordance with the By-Laws of the Cooperative. Rules and Regulations as may be
adopted from time to time by the Cooperative, and rates in effect at the time of the delivery of service.
2. The applicant agrees, when electric service becomes available, that all electric energy used on the premises will be purchased from the Cooperative and will be paid
for at rates currently in effect or as amended from time to time provided, however, that the Cooperative may limit the consumption of electric energy which it shall
be required to furnish the applicant.
3. The applicant agrees that a bill of at least $__________________________ per month will be paid regardless of the number of kilowatt hours consumed and that
this instrument must be considered as a ______________________ year agreement when this section is completed.
4. The applicant agrees to (a) make payment of such membership fee as required by the Cooperative By-Laws, their amendments, and/or Rules and Regulations in
respect to said membership; (b) make such deposits with the Cooperative as may be required by the Cooperative's Rules and Regulations. The acceptance of this
application by the Cooperative shall constitute an agreement between the applicant and Cooperative and the contract for electric service shall continue in force until
cancelled by either party in accordance with the By-Laws and Rules and Regulations of the Cooperative.
5. The applicant, by becoming a member, assumes no personal liability or responsibility for debts or liabilities of Cooperative and it is expressly understood that, under
law, his private property cannot be attached for any such debts or liabilities.
TERMS OF MEMBERSHIP
This membership and all rights and privileges thereto shall begin upon applicants acceptance as a member by the Cooperative Board of
Directors and continue as long as (a) the member purchases electric energy from the service connection designed in said person's application
for membership; and (b) complies with the terms and conditions in respect to membership contained in the By-Laws of the Cooperative and
any amendments thereto and such Rules and Regulations as are adopted from time to time by the Board of Directors.
By: _______________________________ President ___________________________________________________Secretary
THIS MEMBERSHIP IS NOT TRANSFERRABLE. Obligations Accruing to the Cooperative are the Responsibility of the Within Named Member.
BY SIGNING I AGREE THAT ALL THE ABOVE INFORMATION IS CORRECT
Signature
Date
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Co-op FlexPay Agreement
Eligibility
Co-op FlexPay is available only to single phase, non-demand, residential
accounts, including those with outdoor lighting. Residential accounts on Bank
Draft, Budget Billing, Medical Alerts, or that have payment contracts for
anything other than electric use (Example: Heat Pump Loans must be billed
on different account) are not eligible for FlexPay either as a New Member or
as an Existing Member.
I understand that if my account is converted to a Medical Alert Account, I
am no longer eligible for FlexPay. I also understand that all applicable
deposits will apply and any outstanding debt and unbilled usage must be
paid in full._____________________ (initial)
Enrollment
New Members are required to complete a membership application. A
membership fee, a standard connection charge, as well as a minimum
payment for electric use is required for initial service.
Existing Members opting to convert their account to FlexPay must pay in full
all pre-existing fees, total account balance including unbilled usage and a
standard connection charge. Members existing deposits are applied (when
applicable) first to any account balance, then to unbilled usage and any
remaining to their Prepay account, with the understanding that if the
member wishes to convert from FlexPay back to a post pay account, all
applicable deposits will apply and any outstanding debt must be paid in full.
Billing
FlexPay account charges will be calculated and debited daily. These charges
will include electric use as well as other applicable charges and fees including
but not limited to base member charge, outdoor lighting and TVA’s fuel cost
adjustment.
Statements
FlexPay Members do not receive monthly statements. Members may check
balances by calling 865.475.2032 (press option 2) or visiting the AEC web site
www.aecoop.org
. Balances reflect account information as of the previous
day’s meter reading and payments.
Notifications
It is the member’s responsibility to monitor their use. Members agree to
receive periodic courtesy notifications of account balances via an automated
phone call and email. I understand that these notifications will contain
information including account number and current balance. AEC reserves
the right to adjust or add notifications as deemed necessary.
I give permission to be notified via phone calls and email._________ (initial)
I understand that it is my responsibility to provide AEC with accurate
contact information and it is my responsibility to change the notification
options or contact information when necessary. I also understand that
while AEC will make every effort to notify, that notification is not
guaranteed and failure to receive these notifications via phone call or email
shall not release me from payment obligations. ________ (initial)
Payments
Payments can be made in person at AEC headquarters (a $40 minimum
payment is required if made at the office) located at 1109 Hill Drive, New
Market, TN, during normal business hours only. Electronic Checks and Credit
card payments can be made by phone 24 hours a day at 865-475-2032 (press
option 2) or via our website at www.aecoop.org
or by using AEC’s Mobile
App
Fees and Charges
All applicable fees, rates, and charges (excluding security deposits) apply to
FlexPay accounts, including applicable energy charges and customer charges.
An additional monthly FlexPay fee will apply to all participating FlexPay
accounts.
Recovery of Existing Balances
A debt recovery mechanism can be utilized to collect any prior balance or
account charges. The applicant must pay 50% of the outstanding bill,
including any unbilled usage as well as, the required minimum credit as
required for initial service. The remaining balance will be held in Debt
Recovery Account and 25% of each FlexPay payment will be applied to the
existing debt until the debt is satisfied.
Disconnection
An account will be subject to immediate disconnection at any time the
account falls to $0.00 (including weekends, holidays, or during severe
weather conditions). Once the account is disconnected, it will not be
reconnected until balance has met the minimum credit balance requirement
listed on the Schedule of Fees and Service Charges along with all unpaid
usage and standard reconnection fees being paid. If an account is
disconnected and is not reactivated within fourteen (14) days, the account
will be considered inactive and a final bill will be mailed to the last known
address on file.
Reconnection
Members in the FlexPay program understand and agree that disconnected
power will be reconnected without prior notice once a credit balance is re-
established. Members will ensure that electrical safety issues are
addressed prior to re-establishing a credit balance. AEC is not responsible
for damage caused as a result of unsafe conditions in the home when
electric service is re-established. Members must ensure that it is safe to
restore electric service to their home prior to re-establishing a credit
balance. Customer initials __________
Cancellation
Members may cancel their participation in the FlexPay program at any time,
provided that there is a credit balance on the account and an adequate
security deposit is provided at the time of cancellation of the program.
Termination of Electric Service
If a FlexPay member terminates electric service, a refund will be issued of the
remaining credit balance on the account.
Applicant Name
Low Balance Notification When Balance Reaches:
$30.00
Account Number
For Debt Recovery Account
Debt Recovery Balance __________________________
Debt Recovery: 25% of Each Payment
Home Phone – NOTE: This will be the number used for notifications
Email Address:
I/We have read, understand, and agree to comply with all FlexPay requirements and restrictions. Sign below and initial paragraphs above.
___________________________________________________________________ __________________________
Member Signature Date
___________________________________________________________________ __________________________
AEC Representative Signature Date
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SERVICE APPLICATION FORM (Appalachian Electric Cooperative)

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Completed 18 February 2021

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