Account Number(Required) Name(Required) First Middle Last Last 4 Digits of Social Security Number(Required) Phone(Required)Email(Required) Service Address(Required) Street Address Address Line 2 City State 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 ZIP Code Consent(Required) An initial payment of $5 membership fee must be paid along with a payment to put account in credit status to activate a prepay account. If you have a Current balance that you wish to enroll in Debt Management, a minimum of 25% of any payments made will go towards paying off that balance. You must enroll in Smarthub notifications, as Prepay accounts do not have access a regular monthly bill. It is your obligation to be aware of your account balance. Daily account balances and account history (usage, charges, and payments) are available via www.bcremc.smarthub.coop. or on the Smarthub App. Both options will allow you to set up your notifications. You are responsible for managing and updating the notification settings. If your contact information is not current, you will not receive notifications and service may be disconnected as a result. Prepay accounts are not eligible for Payment Arrangements Pledges will be accepted to keep electricity on. Any pledges will be applied as a credit balance to your account. If the funds are gone, your account could be up for disconnect. Your service will be subject to immediate disconnection if the account does not have a credit balance. If service is disconnected, any outstanding balance plus a payment to bring your account back into credit status must be paid to reconnect. Service will be restored remotely using your automated meter after payment has been received. If a returned check or chargeback is received, the amount of the return and a return item fee will be charged back to your account. If this causes the credit on the account to be exhausted, service will be disconnected. If at any time you wish to convert your prepaid account back to a regular billed account, any amount owed would need to be paid in full, and a deposit may be required. Payments may be made in the office, over the phone at (844) 344-4369, online via SmartHub, or by mail. You may see a miscellaneous charge on your Prepay account once a month. This is to balance your Prepay account with our traditional billing. This may show as a credit or a charge to your account depending on your account balance in our billing system. If your account is disconnected and is not reconnected within 7 days, your account will be closed, and you will be mailed a final bill or check to the last known address on file. Service terminated at your request will receive a refund of any remaining credit on the account. I understand it is my responsibility to maintain a credit balance. I have read and understand the terms and conditions of the Prepaid Service AgreementApplicant Electronic Signature (Full Name)(Required) Prepay Options Bad Debt Rollover – If you have a Current balance to enroll in Debt Rollover, a minimum of 25% of any payment you make will go towards paying off that balance.Text Alert Phone NumberNotification Email (If Different from Above) Balance Threshold: (Ex. $20) Smarthub Signup Yes No Bad Debt Rollover Yes No Balance of Debt Rollover Text Alert Notifications Low Balance Pending Disconnect Daily Balance Payment Disconnect Reconnect Email Alert Notifications Low Balance Pending Disconnect Daily Balance Payment Disconnect Reconnect NameThis field is for validation purposes and should be left unchanged.