Electronic Notice Authorization

Name(Required)

First Last

Notification Phone Number(Required)

Service Address(Required)

Street Address Address Line 2 City State ZIP Code

By signing this authorization form, I, the customer, agree that a separate written notice of impending disconnection of service will not be provided. I hereby consent to receiving notifications related to my electrical service. If for any reason I wish to dispute my bill, I will contact Murray Electric System by calling during normal business hours - (270)753-5312.

IT IS MY RESPONSIBILITY AS THE CUSTOMER TO PROVIDE ACCURATE AND UP TO DATE CONTACT INFORMATION TO MURRAY ELECTRIC SYSTEM. MES WILL DOCUMENT ALL ATTEMPTS TO REACH ME, THE ACCOUNT HOLDER, AND A FAILURE TO RECEIVE NOTICE IS MY RESPONSIBILITY, AS THE CUSTOMER. REVISIONS OR CORRECTIONS TO THIS FROM MAY BE MADE BY CALLING MES OR VISITING THE MES OFFICE AT 401 OLIVE ST, MURRAY, KY.

SIGNATURE OF CUSTOMER (PERSON ON BILLING ACCOUNT):(Required)

Electronic Notice Authorization

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