Prepaid Application Prepaid Electric Service Agreement / Terms & Conditions Name* First Last Phone*Email* Service Address* Street Address Address Line 2 City 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 ZIP Code Account Number 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.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. 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. 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. 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. 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. CAPTCHA