FacebookThis field is for validation purposes and should be left unchanged.Business InformationAccount Number(Required)I would like to enroll additional accounts Yes No List Additional Account NumbersClick the + button to add a new row Add RemoveCompany Name(Required)Tax ID NumberTax Exempt Yes No Company Phone(Required)Billing Phone(Required)Email(Required) Date to Connect(Required) MM slash DD slash YYYY Authorized Company RepresentativeName First Middle Last Primary PhoneSecondary PhoneEmail Electric Service DataService Request Type New Construction Service Upgrade Overhead to Underground Conversion Anticipated Date for Permanent Service Month Day Year Temporary Service Needed Yes No DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Electric Service Type Overhead Underground (padmount) Underground (splice box) Entrance SizeConduit & DiameterConductor SizeFacility Type Residential Commercial Industrial Multi-Family Facility Comments for Multi-Family (e.g. # of units per buildingFacility Total Sq-Ft (as per building)# of FloorsFacility Heated with Gas Electric Water Heating Gas Electric Tons-A/CThis facility’s intended use will be (e.g. residential, office space, etc.)?Load & Voltage DataService Type 120/240 1Ø 3W 120/208 3Ø 4Wye 277/480 3Ø 4Wye 120/208/240 3Ø 4Delta 240 3Ø 3Delta 480 3Ø 3Delta Installation Type Overhead (OH) Underground (UG) Overhead Service Size 100 200 320 Underground Service Size 200 320 400+ Overhead Service Size 200 400 600+ Underground Service Size 200 400 600+ Contact Engineering at REMC for other service requests.What will be the true estimated peak demand for this service in kw?Connected LoadsSpace Heating1 Phase kW3 Phase kWA/C Heat Pump1 Phase kW3 Phase kWAir Handler1 Phase kW3 Phase kWLighting1 Phase kW3 Phase kWWater Heating1 Phase kW3 Phase kWCooking1 Phase kW3 Phase kWRefrigeration1 Phase kW3 Phase kWWelding+1 Phase kW3 Phase kWMisc./Recept/LEV1 Phase kW3 Phase kWOther1 Phase kW3 Phase kWOther1 Phase kW3 Phase kWDistribution Transformer InformationPhaseSizeQuantityMotor DataLargest MotorReduced Start Yes No TypeHPVoltagePhasePart Winding & RatioWye-DeltaFLALRASolid StateRamp Setting %:Current Limit%:Autotransformer & Tap Setting %:Other, please describeSecurity LightingSecurity Light?(Required) Yes No Security Light Type(Required) LED Yard Light (4,800 to 6,800 Lumens) – $8.98 per month (existing pole) or $13.32 per month (new pole) LED Wide Flood Light (15,000 to 18,000 Lumens) – $16.06 per month (existing pole) or $20,70 per month (new pole) LED Autobahn Street Light (12,414 to 13,296 Lumens) – $11.84 per month (existing pole) or $16.28 per month (new pole) Agreement for Security and Flood Lighting Service(Required) This agreement made between “Consumer,” party of the first part and Bartholomew County Rural Electric Membership Corporation, a corporation organized under the laws of the State of Indiana, hereinafter referred to as “REMC,” party of the second part. Witnesseth: That for and in consideration of the covenants and agreements of the respective parties hereto, hereinafter set forth, the parties hereto mutually covenant and agree as follows: Section 1. The consumer hereby requests installation of a Security Light on consumer’s premises situated in Bartholomew/Jennings County, Indiana. The location of the units on the premises shall be agreed upon by the parties. Section 2. All security light units shall be installed on REMC poles that Bartholomew County REMC determines adequate where unmetered 120-volt energy is now existing. In case 120-volt unmetered energy is not available at the desired location, the consumer shall pay material and installation costs for additional poles, transformer, overhead and/or underground conductor from point of installation to point of availability. Cost will be calculated as required by Rule 26 of Bartholomew County REMC Service Rules and Regulations. Section 3. Except as otherwise provided in this agreement, the consumer shall pay REMC for the operation of the lighting unit per applicable rate. Bills for lighting service shall be presented monthly by REMC. When a new lighting unit is installed where none exists, the REMC will charge for 12 months usage, billed in monthly increments, upon installation of the lighting unit. If a renter requests a lighting unit be installed, the owner of the property must give approval before the lighting unit will be installed. Section 4. The consumer will protect the unit from damage and injury so far, as is reasonably possible. In case a unit is not operating properly, the consumer shall notify REMC as soon as possible. Section 5. The REMC will furnish, in accordance with the conditions herein set out, all necessary equipment to provide, operate and maintain the lighting system provided for in this contract, and will furnish electric energy for the purpose of energizing the lighting units. Section 6. The operation of the units, and the supplying of electric energy therefore, shall be in accordance with the following provisions: (a) Ownership. The REMC will, in accordance with the terms of this agreement, furnish, provide, install, own, operate and maintain the necessary transmission and distribution lines, wires, conduits, conductors, cable, poles, posts, transformers, lamps, glassware, phono-electric cells, fixtures and other appliances for furnishing lighting service to the consumer. The ownership of the property comprising the lighting system is and shall remain in the REMC, and termination of this agreement for any reason whatsoever shall not in any way affect the ownership by the REMC nor deprive the REMC of the right to enter upon the premises of the consumer and remove any or all property comprising such lighting system, or any part thereof. (b) Maintenance. REMC will repair, replace and maintain all equipment owned by it, including lamps, glassware, and photo-electric cells, which may be necessary to provide continuous operation of the security lighting system, except as hereinafter otherwise provided. (c) Lighting Hours. The lighting hours for the security lighting system shall be on an “all-night” schedule and controlled by a photo-electric cell sensitive to light intensity. (d) Continuity of Service. REMC does not guarantee uninterrupted service from the lighting system, and shall not be liable for any interruption of service when such interruption is without willful default or neglect on the part of REMC, or is due to any cause beyond the control of REMC, or necessary repairs and renewals. However, REMC will service the unit within a reasonable time after notification from consumer that a unit has become inoperative. Normal maintenance will be within 2 normal workdays. (e) Vandalism. Any equipment installed under the agreement which is damaged by acts of vandalism or which is injured in any manner other than by an act of God, may be removed and operation thereof discontinued by REMC without replacement, and in the event of such damage or injury REMC may terminate this agreement by a notice in writing to the consumer effective upon receipt of such notice by consumer. (f) Location. At all times REMC reserves the right to avoid the accusation of creating a traffic hazard or maintaining a nuisance by removal or the relocation of the equipment. In the event of such occasions REMC may terminate this agreement by a notice in writing to the consumer effective upon receipt of such notice by the consumer. Section 7. The term of this agreement during which consumer shall take and REMC shall render service under this agreement shall be 1 year from the date when service is first rendered by REMC pursuant to this agreement. After the original term, this agreement shall continue in force and effect until terminated by either party. Section 8. If the consumer requests the lighting unit be temporarily disconnected, a prorated amount will be billed. No fees are to be charged while the light is disconnected (unless it is within 12 months of new installation) or charged at the time of reconnect. The disconnection and reconnection will be made at the company’s convenience. Section 9. This agreement shall be binding upon and ensure to the benefit of the parties hereto and their respective successors or assigns. 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.AgreementConsent(Required) I hereby request electric service from the Bartholomew County Rural Electric Membership Corporation and herewith make application for membership in this corporation. I agree to be bound by the Articles of Incorporation, the By-Laws, and amendments thereto, and such rules and regulations as may be adopted from time to time by the Board of Directors. I agree to pay $5 Refundable Membership Fee and Deposit, if applicable, to initiate service in my name. I agree, for us to service your account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or emails, using any email address you provide us. Methods of contact may include using pre-recorded or artificial voice messages and/or the use of an automatic dialing device, as applicable. Message and data rates may apply. I/We have read this disclosure and agree that Bartholomew County REMC may contact me/us as described above. Bylaws and Rules & Regulations are available on our website or by request. 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.
