GreyStone Power Corporation

Residential Service Request

Please complete this form to apply for brand new service, conversion to Prepaid service, or to transfer from one location to another.
Please allow 3 business days for processing of all orders.

NOTE: Fields marked * are required. Incomplete applications will not be processed.
The following information will be used for the purpose of a credit check.

Completion of this form will not establish service if additional information is needed. A review will be conducted and any arrangements needed to collect the necessary deposit must be satisfied before this application for service can be completed and service connected. A valid contact name, e-mail address and phone number are required. Any phone number provided, including wireless, may be used by GreyStone Power to contact you.

Please verify that the Residence is in the GreyStone service area.

*Is this address new construction?:
If new construction, is the service temporary or permanent?
Temporary or Permanent?:
1. Enter the Street Number of the Residence. For example, if your address is 3425 Main Street Apt 16 then enter 3425. Enter only the street number. NOT THE ENTIRE ADDRESS.
*Street Number:
2. If there is an Apartment, Lot or Unit Number, enter it here, otherwise leave it blank. For example, if your address is 3425 Main Street Apt 16 then enter 16. Enter only the Apt/Lot/Unit number. NOT THE ADDRESS.
Apt/Lot (if applicable):
3. Click the "Find Matching Addresses" button.

4. Select your address from the list below.
List of Matching Addresses:
If your address is not included in the list, first confirm that the street number is correct and verify the address is in the GreyStone Service Area. If New Construction, then type the address in the New Address box, below. Commercial accounts can not use this form.
New Address:
*New City:
*New Zip:
GreyStone Location ID:

When should service start?

*Service Start Date:

Would you like Postpaid (regular) Billing or Prepaid Billing?

With Postpaid Billing you use power up front and pay for it later. GreyStone Power bills members monthly for usage and payment is due when rendered. Members using Postpaid Billing may be required to pay a deposit based upon credit history. The deposit is returned to members when they leave the system or after 18 consecutive months with on time payments.

Looking to take control of your energy usage and customize your payment schedule? A Prepaid account gives you the flexibility for when and how much you wish to pay - without deposits, late charges, disconnect or reconnect fees. Click here to read more about how our prepaid program can work for you!

*Type of Billing:

Please tell us about yourself:

Enter your Full Legal Name as it appears on your driver’s license, passport, birth certificate, or other legal identification document.
*First Name:
*Last Name:
Middle Initial:
*Date of Birth:
*Social Security Number:
Check the box below if you do NOT have a driver's license.
	No Driver's License:
*Driver's License Number:
*State Issued:
*Expiration Date:
Check the box below if you are NOT employed.
	Not Employed:
*Employer:
*Employer Phone Number:

Authorized Person on Account Information:

Select the relationship of the Authorized Person to the Account holder. If Power of Attorney (POA) is selected, the POA documents and copy of driver's license are required to be uploaded below.
*Relationship of Authorized Person:
Upload POA document(s):
Upload POA copy of driver's license:
Authorized Person's Name:
Authorized Person's Social Security No:
Authorized Person's Cell Phone:
Check the box below if the Authorized Person is NOT employed.
	Authorized Person Not Employed:
Employer:
Employer Phone Number:

Where do you currently live?

*Current Address:
Apt/Lot Number:
*Current City:
*Current State:
*Current Zip:

Who currently provides your Electric Service?

Check the box below if there is no current service provider.
	No Current Provider:
Present Power Supplier:
Power Supplier State:

Please tell us about the Residence

*Type of Heat:
Type of Heat (if Other):
Do you own or rent the Residence?
*Own/Rent:	Own Rent

If renting the Residence, please provide Landlord information here:

Landlord Name:
Landlord Phone Number:
Landlord Address:
Landlord City:
Landlord State:
Landlord Zip:

Do you wish to enroll in E-Bill?

If checked, bill notifications will be sent to the email address you provide below.

Enroll in E-Bill:

Other offers:

Take advantage of these offers to enhance your membership! Click the links below for more information. By signing this application, you consent to our partners contacting you in the coming days with offers that may be beneficial to you.

EMC Security - Home protection for as little as $16.95/month
	I'd like to know more:
Gas South - Receive a permanent discount on great low rates, no deposit (save up to $150) plus savings in bill credits when you sign up with Gas South!

Operation Roundup - Round to the next dollar to donate to worthy charities in our area
	Yes, I'm requesting traditional billing (not Prepaid) and wish to enroll in Operation Round Up:

Where should we mail your bill?

	Check here if same as Service Address:
Mailing Address:
Apt Number:
Mailing Address City:
Mailing Address State:
Mailing Address Zip:

Contact Information:

For Prepaid service your mobile number and carrier are required.
*Home Phone Number:
Mobile Phone Number:
Mobile Carrier:
Do you want text alerts?:
Work Phone Number:
Fax Phone Number:
*Request Submitted By:	(Full Name)
*Email Address:
Enter the email address again for accuracy.
*Email Address:
*Daytime Telephone Number:	(M-F between 8 AM & 5 PM)
Best time to call:

Relative Contact - Nearest Relative NOT Living in Household:

*Relative Name:
*Relation to Applicant:
*Relative Phone Number:
*Relative Address:
*Relative City:
*Relative State:
*Relative Zip:

AGREEMENT
READ BELOW, THEN SUBMIT APPLICATION AND AGREEMENT
(WITH SUBMIT BUTTON AT BOTTOM OF AGREEMENT)

The Applicant hereby applies for membership in, and agrees to purchase electric energy from, GreyStone Power Corporation (the Cooperative), on the terms and conditions specified below. The Applicant further represents, warrants and/or agrees:

1. CONTRACT FOR ELECTRIC SERVICE - Applicant agrees to comply with this Application and with, as they currently exist or as they are later adopted or amended, the Cooperative's Governing Documents. As used herein, the "Governing Documents" shall be the Cooperative's: (a) articles of incorporation; (b) bylaws; (c) service rules and regulations; (d) rate or price schedules; and (e) rules, regulations, and actions adopted, taken, or approved by the Cooperative's board of directors. The acceptance of this Application shall constitute a contract for electric service between Applicant and the Cooperative, in accordance with the terms specified in the Governing Documents. Applicant warrants that all information in this Application is true and complete and is made for the purpose of having the Cooperative supply electrical service to the service address specified. Copies of the Governing Documents, which are on file in the Cooperative's principal office at Douglasville and may be available on the Cooperative's website, have been furnished Applicant or made available to Applicant, and are incorporated into this Application to the same effect as though fully set forth herein.
2. VERIFICATION OF INFORMATION; DEPOSIT - Applicant authorizes the Cooperative to obtain information about Applicant, and to verify any information provided by Applicant, and to make, use or provide credit reports to or from credit reporting agencies and others. Applicant agrees to deposit with the Cooperative such consumer's deposit as may be required by the Governing Documents. The deposit shall not bear interest. The Applicant authorizes the Cooperative to allocate any payment, deposit or membership fee received from the Applicant to any, or all, of Applicant's accounts with the Cooperative. Any portion of the deposit(s) that is not applied to payment of bills or other amounts due the Cooperative shall be refunded to Applicant in accordance with the Governing Documents.
3. ENERGY PURCHASES - All central station electric energy used on the premises shall be purchased from the Cooperative and will be paid for in the manner, and at the rates, charges, and fees established in accordance with the Governing Documents.
4. EASEMENTS - Upon being requested to do so by the Cooperative, Applicant shall provide and deliver to the Cooperative grants of easement or right-of-way over, on or under such land owned or leased by the Applicant and in accordance with such reasonable terms and conditions as the Cooperative shall require for the furnishing of electric service to Applicant or other applicants or for the construction, operation, maintenance or relocation of the Cooperative's electric facilities.
5. RIGHT OF ACCESS - All service lines supplying the Applicant with electric energy and all meters, switches and other equipment constructed or installed by the Cooperative or its agents over, on, or under said premises, shall at all times be the sole property of the Cooperative which shall have the right of access to the said premises at all reasonable times for the purpose of reading meters, right-of-way maintenance, testing, inspecting, repairing, removing, maintaining, or exchanging any or all equipment and facilities.
6. INTERRUPTION OF SERVICE - Although the Cooperative shall use its best efforts to furnish Applicant and its other members with adequate and dependable electric service, the Cooperative cannot, and does not, guarantee adequate or uninterrupted electric service. Applicant shall ensure that all three-phase motors and/or loads shall have overload devices on each of the three-phase wires to insure proper protection for the motor. The Applicant acknowledges that electric service may be disconnected, established and restored remotely, and Applicant must ensure all electric appliances, and the premises in general, are rendered in a condition safe to be energized upon receipt of payment, restoration of facilities, or other reason prompting re-initiation of electric service.
7. EQUIPMENT DAMAGES, TAMPERING OR BYPASSING - The Applicant acknowledges that the Governing Documents and Georgia law provide that penalties may be imposed on the Applicant in the event any Cooperative facilities or equipment located on property owned by or leased to Applicant are interfered with, impaired in their operation, by-passed or damaged. Such penalties include, but are not limited to, the Cooperative's cost of investigation, repairing, replacing, or relocating any such facilities and its loss, if any, of revenues from the failure or defective functioning of its metering equipment.
8. WIRING OF PREMISES - Applicant represents and warrants that all premises served by the Cooperative and owned or occupied by Applicant are, and shall remain, wired in accordance with the specifications of the National Electric Code, any applicable state code or local government ordinances, and with any directives of the Cooperative.
9. CAPITAL CREDITS - The Cooperative is a non-profit cooperative, and may allocate to Applicant patronage capital ("Capital Credits") in accordance with the Governing Documents. The Applicant authorizes the Cooperative to deduct, recoup, or set-off any amount of Capital Credits that may become payable to the Applicant in partial or full satisfaction of any debt Applicant may have to the Cooperative. The Applicant hereby: (a) grants to the Cooperative a security interest in Applicant's past, present and future rights to the Capital Credits, and (b) authorizes the Cooperative to file a financing statement perfecting said security interest.

PREPAID TERMS and CONDITIONS

1. SECURITY DEPOSITS, LATE FEES AND COLLECTION FEES - As a prepaid member, the normal security deposit for a residential account is not required and you are not subject to normal residential account late fees and collection fees.
2. NEW MEMBERS - Those electing prepaid metering will need to complete a membership application if an application is not currently on file for the prepaid service location. A membership fee of $10.00, a processing fee of $22.00, and a minimum of $75.00 for daily usage and monthly fees ($107.00 minimum total) are required for initial service.
3. EXISTING MEMBERS - When your account is converted to prepaid, your existing deposit (if applicable) is applied toward any outstanding balances with the remaining credit (if applicable) applied to your prepaid service. Normally all fees and unbilled energy must be paid before an account can be converted from post paid to prepaid. Any exceptions to the normal process must be reviewed and approved by management. Accounts will be charged normal monthly service charges.
4. BILL VIEWING AND ALERTS - GreyStone is providing a service where you can call for or view your daily usage, receive alerts, and make smaller payments as often as you would like or as your budget allows. This service does not require a security deposit. It is your responsibility to ensure that you update your phone number and or contact information to ensure you are able to receive necessary system alerts to avoid interruption in service. The website, www.greystonepower.com, will also allow you to modify your alert settings. You are solely responsible for managing and updating the alert settings on your prepaid account(s). If your contact information is not current in the system, you will not receive alerts and service may be disconnected without further notice.
5. BILL CALCULATION, DISCONNECTION AND MINIMUM PAYMENTS FOR RECONNECTION - The prepaid account will be calculated daily with daily adjustments of all charges and fees to the prepaid credit balance and reconciled once per month using the applicable rate and adjustments for the month. A prepaid account will be subject to disconnection any time your account does not have a credit balance, including weekends, holidays or during severe weather conditions. Any returned payments received on the account will be charged to the member's account immediately. If this causes the credit balance on the account to be exhausted, service will be disconnected within 24 hours. Any tampering-related fees will subject the account to immediate disconnection and must be paid before service is reconnected. You will be required to purchase a minimum of $10.00 of prepaid electric service plus any unpaid balance that was due at the time of disconnection before service is reconnected.
6. PAYMENTS - Can be made in any amount at a GreyStone office during working hours or 24 hours a day, 365 days a year for debit card, credit card and e-checks through GreyStone's IVR system at 770-942-6576 or by logging on to www.greystonepower.com.
7. BILLING - Prepaid accounts do not receive paper statements (bills). If you are registered for GreyStone's e-bill service, disregard any e-mails stating your bill is viewable online, because this information will not be relevant to your prepaid account. Daily prepaid account history (usage, charges and payments) will be available via the internet at www.greystonepower.com.
8. If an account is disconnected and does not become active for five (5) consecutive days, the account may be considered inactive and GreyStone will mail a final bill to the last known address on file.
9. TERMINATION OF SERVICE AND FINAL BILLING - A full settlement of the account shall be made when participation in the service ends and the account is final billed. Service terminated at the member's request will receive a refund of any remaining credit on the account.
10. CONVERSION TO POST-PAID SERVICE - You may elect to convert your account to post-paid service, at which time the Cooperative may require full payment of the deposit as a condition of continued service.
I UNDERSTAND THE RESIDENTIAL PREPAID METERING TERMS OF SERVICE AND THAT IT IS MY RESPONSIBILITY TO MAKE SURE THAT I MAINTAIN A CREDIT BALANCE FOR UNINTERRUPTED SERVICE.

I accept the Terms and Conditions described above. To the best of my knowledge the application is accurate and complete.

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Signature

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