Prepaid Application Prepaid Electric Service Agreement / Terms & Conditions Have you ever received electrical service from Norris Public Power District?*(Service will not be furnished to former customers until all indebtedness owed to Norris Public Power District is paid in full.) Yes No New construction (request for electrical facilities to be built)* Yes No If YES to new construction, describe what service will be used for (residence, grain drying, poultry farm, etc.)Service Description (describe what business will be used for)Name* First Last Property Address*(If applicable, provide Subdivision Name, Block Number and Lot Number) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Account Number(If changing from Standard Billing to Prepaid Billing, provide your existing account number.)Social Security Number or Federal ID Number*(Must provide a minimum of the last four digits of either your SS# or Fed ID #)Birth Date* MM slash DD slash YYYY Driver's License NumberDriver's License StateCellular Phone Number*Home Phone Number*Email* Co-Applicant InformationThe co-applicant is also responsible for payment on the account.Name First Middle Last Social Security Number(Must provide a minimum of the last four digits of either your SS# or Fed ID #)Birth Date MM slash DD slash YYYY Driver's License NumberDriver's License StateCellular Phone NumberHome Phone NumberEmail Preferred Phone Number To Receive Billing and Service Information Automated Calls*OwnershipDo you own or rent this property?* Own Rent Name of Previous Owner or Tenant (if available)Landlord Name (if applicable)Landlord Phone Number (if applicable)Service Start Date*Service start date must be a current or future date. We cannot back date. Holiday and weekend requests will be scheduled the next business day. MM slash DD slash YYYY I hereby voluntarily apply to participate in Prepaid Electric Service offered to customers of Norris Public Power District (hereinafter called "the District"), and unequivocally agree to the following terms and conditions: 1. I agree to purchase electric service from the District under its optional Prepaid Electric Service and agree to be bound by its Terms and Conditions and by the District’s Rate Schedules and Service Regulations as they are now in effect and as may hereafter be amended. 2. I represent that I am the owner or lawful occupant of the property to be affected by this agreement, and I have the right and authority to execute this agreement. 3. I understand that if I am a former District customer re-establishing an account, any uncollected balances from previous accounts must be paid in full before the new service can be connected. 4. I understand that payment on my Prepaid Electric Service must be made by cash, credit or debit card, or MoneyGram and that prepaid accounts are not eligible for payment arrangements, automated payments or budget billing. 5. I understand that if I apply for energy assistance, my account will be credited when the District receives the funds from the agency or charitable organization. I understand that I am responsible for notifying the energy assistance agency of my enrollment in Prepaid Electric Service. 6. I understand that a Prepaid credit balance must be maintained in my account at all times to cover daily electric charges including energy charges, customer charges, device charges, taxes and lease fees if applicable. If I elect to participate in Operation Round Up, the Round Up contribution will be applied to the account once per month. 7. I understand that electric charges will be calculated daily and if I allow my Prepaid account to reach a zero dollar ($0.00) balance my electric service will be automatically disconnected without further notice, with no delay or exceptions, including during inclement weather or extreme temperatures. Electrical service will automatically resume after I re-establish a minimum credit balance via an acceptable payment method.Customer Initial for Terms & Conditions #7*8. I agree to make a $50.00 minimum initial prepayment to my Prepaid Electric Service account for future electricity use. 9. I agree that an existing deposit on my account will be applied to my outstanding balance or unbilled usage (if any) at the commencement of participation in Prepaid Electric Service, and any credit remaining after application of the deposit shall be applied to satisfy the initial required account balance. 10. I understand that I will not receive paper billing statements or disconnect notices and that I must register to receive account information and notices via SmartHub. Any notice from the District required hereunder shall be pursuant to the preferred method(s) of notification I select in SmartHub. I expressly consent to receiving the notifications, even if such notification is provided via automated technology. I understand that my telephone company may impose charges on me for these contacts. I understand that it is my sole responsibility to update my SmartHub account should there be any changes to my contact information.Customer Initial for Terms & Conditions #10*11. I agree that it is solely my responsibility to regularly monitor the balance on my Prepaid Electric Service account. 12. I understand that should my balance reach zero dollars ($0.00) or greater, my service will be automatically disconnected. Upon disconnection, I understand that if I, or a member of my household, rely upon medical equipment powered by electric energy, or if the service supplies electricity necessary for the survival of livestock of any kind, I am completely responsible for procuring alternate electric power or timely re-establishing service from the District by adhering to the requirements for same set forth herein and in all applicable policies of the District.Customer Initial for Terms & Conditions #12*13. I understand that failure to receive notice of impending disconnection will not exempt my service from disconnection. 14. I understand that before my service will be reconnected, I will have to establish a minimum credit of $20.00 to be used for future purchases of electricity. In addition, I must pay for any outstanding balance due. 15. I give the District express permission and authorization to reconnect my meter remotely. Customer is solely responsible for any and all electrical safety issues that could be present when power is restored. The District assumes no responsibility for damage caused as a result of unsafe conditions in the home when electric service is reconnected.Customer Initial for Terms & Conditions #15*16. I understand that if the service is disconnected due to a credit deficit and remains disconnected for a minimum of 7 days, the account will be considered inactive and a final bill will be mailed. 17. I understand the District reserves the right to remove my account from Prepaid Electric Service at any time, without consent or notification. The District reserves the right to modify or end this program at any time. 18. I understand that I may withdraw from Prepaid Electric Service at any time and convert to a post-paid account by paying any outstanding balance I owe and establishing a deposit consistent with District Service Regulations. There is a 12-month waiting period from the date of withdrawal before I may re-enroll in Prepaid. 19. I understand that any tampering with the District’s equipment will result in one or more of the following: disconnection of service, payment of additional fees, and possible legal action. 20. I understand that if my Prepaid Electric Service account is discontinued or terminated, the District may transfer any balance to any other like-account I may have with the District or refer any unpaid balance to the District’s third-party collection agency. I, the undersigned, HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND HOLD HARMLESS, the District, its respective agents, employees, assigns or representatives FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES CAUSED IN WHOLE OR IN PART by my participation in Prepaid Electric Service. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE SURRENDERED SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE. I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.Applicant Signature* First Last Date* MM slash DD slash YYYY Terms & Conditions* I have read and agree to all the Terms and Conditions in the Prepaid Electric Service Agreement.By submitting the Prepaid Electric Service Agreement, the applicant/applicants hereby make/makes application to Norris Public Power District to furnish, electric service, subject to the following rules and regulations: 1. In consideration of the District making electric service available, the applicant will purchase from the District electric energy and pay in accordance with the applicable Rate Schedule and Service Regulations of the District. 2. Electric energy furnished by the District shall become the responsibility of the applicant after it passes the meter. The applicant shall be responsible for operation, maintenance, replacement and renewal expenses on all customer-owned equipment, including all equipment beyond the metering point provided by the District. 3. The applicant hereby subscribes to the Norris Electric News and authorizes the District to include publishing costs in the applicable Rate Schedule. 4. The District shall have the right of ingress and egress on the above mentioned applicant’s property for the purpose of constructing, operating and maintaining their line, including the right to cut, trim or remove trees, shrubbery or other obstacles necessary to protect the District’s lines and facilities. 5. All new services must be approved by the District’s engineering department and when District policy requires, the customer shall sign a contract and make all payments specified by District Service Regulations before start of construction of services. The initial billing period shall start when customer begins using electric power and energy, or thirty (30) days after the service is available hereunder, whichever shall occur first. 6. The District reserves the right to deny or terminate electrical service to the customer at any location within the District’s service territory for non‐payment of charges arising from this application or any other contract entered into between the District and the customer. 7. The District reserves the right to provide renter service information to property owners or managers upon request.I choose to participate in the following program/service: Operation Round Up If you choose not to participate in the following program/service, please uncheck the box above.Terms and ConditionsBy providing Norris Public Power District your phone number, you are giving express written consent to call or send electronic notifications regarding your account to the number provided in the Applicant's information. I have read and agree with the Terms and Conditions CAPTCHA