Authorization to Release Account Information Form

Security, Security, Security

Your personal information is valuable and we want to ensure our members that we are doing everything possible to guarantee your personal information is not compromised in any form. By focusing on prevention, Jay County REMC can reduce the risk of identity theft and prevent your information from being obtained without authorization.

If you would like to add a person who can conduct a limited amount of business on your behalf, please click here to print and fill out an Authorization to Release Account Information form. Without this authorization, only you will have access to your information. Please be sure to include your spouse, as the majority of our memberships are sole memberships.

Please note that by signing the authorization form, this does not make your account a joint membership. If you would like your account to be a joint membership, which gives your spouse all rights and privileges of a member, you can call our office at (800) 835-7362 or go to the Membership Form page.

Please fill out the Authorization to Release Account Information form completely and return it to our office. Upon receipt of the completed form, we will make the appropriate updates to your account. Please remember, this authorization will remain in effect until it is withdrawn in writing and delivered to Jay County REMC. 

If you have any questions or are unsure of who the legal member is on the account, please call our office at 260-726-7121 or 800-835-7362. We want to keep you and your information secure!

Forms can be returned or mailed to: 484 S 200 W, Portland, IN 47371