FlexPay Agreement NOTE *FlexPay accounts are only available for a livable residence.Date Service Requested (mm/dd/yyyy)(Required) Month Day Year Service Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Property Status(Required) Own Home Rent Landlord Is the mailing address the same as the service address?(Required) Yes No Applicant's Name(Required) First Last Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Date of Birth (mm/dd/yyyy)(Required) Month Day Year Social Security Number(Required) Driver's License NumberState(Required) AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Employer Marital Status(Required) Single Married Spouse's Name(Required) First Last Date of Birth (mm/dd/yyyy)(Required) Month Day Year Spouse's Social Security Number(Required) Driver's License NumberState(Required) AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PhoneEmail Employer We require a valid ID. We accept several forms of identification as listed below. One of the primary IDs must be a photo ID.PRIMARYValid US Driver’s License | Gun Carry Permit | Passport or Passport Card | Military Identification | Green Card | Consular ID Card | US Employment Authorization Card | Permanent Resident Card | State Issued Identification | SECONDARYBirth Certificate | Social Security Card | Insurance Card | Voter Registration Card | Property Tax Receipt | Posted Mail with Applicant's Name | Utility Bill | Lease Agreement or Mortgage Statement | College Enrollment Papers | Vehicle Registration | Upload Two Forms of ID(Required)Please take pictures and upload two forms of ID below. Drop files here or Select files Accepted file types: gif, jpeg, jpg, pdf, png, Max. file size: 300 MB, Max. files: 5. 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. 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. 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. The applicant agrees that a bill of the amount listed below will be paid regardless of the number of kilowatt hours consumed and that this instrument must be considered as a agreement when this section is completed. 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. 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 liabilitiesTerms of Membership(Required) 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. This membership is not transferrable. Obligations accruing to the cooperative are the responsibility of the within named member. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Applicant's Electronic Signature (Full Name)(Required) A low balance notification will be sent.Email Is this a debt recovery account? Yes No Unsure Debt Recovery Balance:(Required)25% of each payment. Consent(Required) 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. 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 our website. 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. 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. 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 or by using AEC’s Mobile App Fees & 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 (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 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. 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. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Applicant's Electronic Signature (Full Name)(Required) All information submitted in this form has AES-256 encryption to protect your personal information.CommentsThis field is for validation purposes and should be left unchanged.
