Prepay Your Way Agreement Member name(s) Account # or service address Phone # An automated phone call will be sent to the phone number listed for low balance notifications, unless you opt-out of receiving notifications at that number. Low balance alerts can also be received via text message or email by updating your SmartHub settings. Low balance alerts I want to receive daily low balance alerts when: Low balance alerts balance is at or below five projected days of electric use. a specific balance left on my account of Enter balance amount I agree to the terms of service. All members must have an Application for Electric Service & Co-op Membership on file. A credit check will be run to determin the security deposit for: members that request to leave Prepay Your Way Accounts removed from Prepay Your Way by the Cooperative Prepay Your Way members are responsible for the timely purchase of power from the Cooperative and keeping their contact information current. Energy assistance payments will be posted to Prepay Your Way accounts when received by the Cooperative. Electric service will be subject to disconnection at any time the prepay account runs out of money, even if prepay balance low alerts cannot be delivered. Weather conditions will not postpone disconnection of service. Any non-sufficient checks, electronic fund transfers or returned credit card payments and associated fees will be applied to the account and may result in disconnection of service without further notice. Sixteen days after service has been disconnected, the account will be removed from Prepay Your Way and a final bill will be mailed. Disconnect/Reconnect fees may apply. When the account runs out of money, a $100 disconnect fee and $100 reconnect fee may be applied to the account. Reconnects are scheduled Monday through Saturday between 8 a.m. and 8 p.m. and an additional $50 is required to reconnect services Saturdays, after 4:30 p.m. weekdays or on holidays. Prepay Your Way was not designed for seasonal disconnects and reconnects. A $200 disconnect/reconnect fee will be required to be paid in full prior to the reconnection of service. Agreeing to the terms of service affirms there are are no residents in the home that will be impacted by the loss of electric service. Should this status change, it is the member's responsibility to notify and provide the Cooperative with a Critical Medical Form completed and signed by a Licensed Medical Doctor. Once this form is received, the acocunt will be removed from Prepay Your Way. Prepay Your Way accounts are not eligible for payment arrangements. Landlords with accounts in their name agree to allow Polk-Burnett to release information to tenants. Tenants with accounts in their name agree to allow Polk-Burnett to release information to landlords. The Cooperative, its directors, officers, employees, agents and representatives shall be held harmless from any claims, disputes, actions, damages or liabilities due to loss of electric service as a result of participating in Prepay Your Way. Polk-Burnett reserves the right to remove any member from Prepay Your Way at any time, without consent or notification and to modify or end this program at any time. A monthly paper statement will not be received, unless requested. Statements can be accessed at anytime through SmartHub. Member's signature Sign below Reset CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit