r You will not be able to submit this form before speaking to a customer service representative and attaining an account number. Call 800-889-6832 Option 1 for more information. CLICK TO CLOSE Prepay Step 1 of 3 33% Applicant Name * Required First Last Account Number * RequiredPlease call our office at 800-889-6832, Option 1 for the information required for the above field. Map Location NumberEmail * Required PhoneThe member authorizes Cooperative to transfer the outstanding balance of the amount below from the member's account with the Cooperative to the Pre-Pay account and, further, agrees that fifty percent (50%) of any payments made to this account in the future shall be applied to the balance until said balance is paid in full.*The member authorizes Cooperative to transfer the outstanding balance of the amount below from the member's account with the Cooperative to the Pre-Pay account and, further, agrees that fifty percent (50%) of any payments made to this account in the future shall be applied to the balance until said balance is paid in full.Please call our office at 800-889-6832, Option 1 for the information required for the above field. Agree to Terms & ConditionsAGREEMENT FOR PARTICIPATION IN PRE-PAY PROGRAM The undersigned (hereinafter called the “Member”) hereby applies for participation in the Pre-Pay Program offered to members of OsageValley Electric Cooperative (hereinafter called the “Cooperative”), and agrees with the Cooperative to follow the following terms and conditions: The member shall purchase electric energy from the Cooperative in accordance with the present and any future rate schedule of theCooperative on a Pre-Pay basis for the above-referenced account. The member understands that the terms and conditions set forth in the member’s Application For Membership and/or Electric Service continue to apply in addition to the terms and conditions of this Agreement and Pre-Pay Program, subject, however, to any changes set forth in this Agreement. Member agrees to receive communication via electronically generated notifications from the cooperative. The member shall pay any membership, transfer, connect and/or applicable fees as fixed by the Cooperative’s by-laws and the policies, rules and regulations of the Board of Directors as may be required for the member to participate in the Pre-Pay Program. Any deposit fee previously paid by the member to the Cooperative will be applied to the member’s outstanding balance at the commencement of participation in the Pre-Pay Program and any credit remaining after application of the deposit fee shall be applied to the member’s Pre-Pay account balance. If the member chooses to withdraw from the prepay program and convert to “conventional” status, the member will be required to pay a $600 deposit. As a result of participation in the Pre-Pay Program, the member will not be mailed a monthly statement of electric usage or other applicable fees or charges. If the member requests an In Home Display unit, a fee of $6.00 per month will be applied to the account. The member shall be responsible to regularly monitor the balance on the Pre-Pay account and understands that electric service will be subject to disconnection including weekends and holidays without any written notification from theCooperative to the member once the balance of the account reaches zero ($0.00). The member shall pay any return payment fees and service fees and, further agrees that all such applicable fees are required to be paid in full before any member payments are applied to the balance of the Pre-Pay account. The member understands the medical and health conditions of any person located at the address where electric service is furnished by Cooperative and/or inclement weather conditions or temperatures will not postpone disconnection of electric service. Prepay accounts shall not be eligible for payment arrangements with the Cooperative and energy assistance shall not be applied until received as payment on the member’s Pre-Pay account. Member MUST notify the Cooperative to discontinue service when member moves from the above mentioned service map location. Member will be responsible for all daily charges incurred until notification to discontinue service has been received. Name of Person Completing This FormName * Required First Last Signature * RequiredI understand that this digital signature constitutes a legal signature confirming that I acknowledge and agree to the terms of this application. Submit This iframe contains the logic required to handle Ajax powered Gravity Forms.