Start/Stop Service

if applicable...

residence where service is being requested

(yyyy/mm/dd)


(yyyy/mm/dd)

(000-000-0000)

(000-000-0000)

(000-000-0000)


***(please fill out if joint membership)***

***(please fill out if joint membership)***

(yyyy/mm/dd)

(000-000-0000)


if different than above


Buying
Buying on Contract
Renting

(000-000-0000)

(000-000-0000)



REQUIREMENTS FOR MEMBERSHIP & ELECTRIC SERVICE

  • The undersigned (hereinafter called the Applicant) agrees to comply with and be bound by the Articles of Incorporation of the Cooperative, by the By-laws of the Cooperative and any amendments thereto, and such Rules and Regulations as may be adopted from time to time by the Cooperative. Member understands that $5.00 of the amount paid to receive electric service from Harrison REMC each year is for a subscription to Electric Consumer.
  • The applicant agrees, when electric service becomes available, that all electric energy use on the premise will be purchased from the Cooperative and will be paid therefore monthly at rates to be determined from time to time in accordance with the By-laws of Cooperative.
  • The applicant agrees to deposit with the Cooperative such consumer deposit that may be required by the By-laws and Policies of the Cooperative.
  • Any portion of said deposit not applied to payment of bills due to the Cooperative will be returned to the applicant either; 1.) upon termination of service OR 2.) if service has not been terminated, refund will be made at the cooperative’s discretion.
  • Interest upon deposit will be paid according to REMC Policy.
  • The acceptance of this application by the Cooperative shall constitute an acceptance to membership in the cooperative with such rights and liabilities as are specified in the By-laws of the Cooperative, provided however that said membership shall terminate when the Applicant ceases to purchase electric energy from the Cooperative.
  • The applicant, by becoming a member, assumes no personal liability or responsibility for any debts of the Cooperative, as is expressly understood that under law his private property cannot be attached for any such debt of liabilities.
  • I authorize Harrison REMC to contact me by phone call, text message, or email for the purpose of notifying me of a past due bill and/or pending service disconnection.

 Typing your full name in all capital letters will confirm your digital signature, and your agreement with the requirements for membership and the following statement.

 I attest that everything I have stated in the application is correct to the best of my knowledge and I agree to comply with all of the REMC membership requirements listed above. I also understand that service will be disconnected if the REMC does not receive a copy of my drivers license and  deposit (if required) within 3 business days.

Please email a copy of your drivers license to serviceorders@harrisonremc.com.

The service connection fee will be $35.00 added to the first bill.
REMC will contact you to complete a credit check. A security deposit may be required.

Type your full name in all capital letters to confirm your digital signature.

Type your full name in all capital letters to confirm your digital signature.


 

 


CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.
Together We Save