The Power to Improve Your Life

Never worry aboutexpensive electrical surge

damage again

SURGEPROTECTION

PROGRAM

Model 1 To protect most electronics, choose the single plug (Model 1). It is perfect for stereo systems, CD players, microwave ovens, or any other devices without additional telephone or cable TV connections.

Model 2To protect electronics with phone connections and DSL, choose Model 2. This single-plug model is great for phones, answering machines, computers and fax machines.

Model 3Televisions and compatible devices, such as cable TV receivers, game systems, DVD and Blu-ray players, are protected with Model 3.

Model 4For protection of multiple electronics, including satellite dish protection, use the 8-plug surge protection model with modem and coaxial (Model 4). This model protects phones, computers, cable TV receivers and satellite TV receivers.

850 Commerce Road | P.O. Box 38 | Jefferson, GA 30549

www.jacksonemc.com

10/2014

ORDER FORMPlug-in Protector Devices For ElectronicsModel # Qty. Price Total

1-SOPPS ____ $17 ea. $_________Single Outlet

2-SOPPT ____ $17 ea. $_________Single Outlet with Modem

3-SOPPC ____ $17 ea. $_________Single Outlet with Coaxial

4-1500DRJ ____ $88 ea. $_________8-Outlet w/Modem and Coaxial

Subtotal $_________

Sales Tax $_________

TOTAL COST $_________

Ordering Information

Ship To _________________________________________________

Address _________________________________________________

City _______________________ State _______ Zip ____________

Daytime Phone ___________________________________________

Account # ______________________________________________

Method of Payment (*Subject to approval)

Cash Check (Check Enclosed)

Charge total amount on next bill (Jackson EMC customers/members only)*

Charge total amount over 3 months (Jackson EMC customers/members only)*

Discover/VISA/MasterCard

For payment by credit card, please provide the information below. There is a $3.50 charge for credit card transactions.

Discover VISA MasterCard

Credit Card Number

Expiration Date

Signature ________________________________________________

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

m m m

m

m

m

m m

MONTH YEAR

With Jackson EMC’s Surge Protection for Electronics, your valuable electronics are protected against damage due to lightning or power surges. These devices are designed to keep lightning from ever reaching your computer, TV, DVD and Blu-ray players, or any electronic device plugged in. If they don’t, your electronics will be replaced or repaired, free of charge! **

**Warranty Coverage (Residential only, not commercial)PSP TVSS are warrantied for life. If a surge should pass through a PSP TVSS and the TVSS fails, causing consequential damage to the equipment correctly connected to it, PSP will pay up to $25,000 per occurrence for repair or replacement with a $6 million limit per location. PSP Products, Inc., handles claims.

For more information, visit jacksonemc.com/surge or call Jackson EMC customer service at 1-800-462-3691.

PROTECTYOUR ELECTRONICSFROM POWER SURGES!

Customer Cost

JEMC Acct # Date

Name Phone #

Address

City Zip County

SERVICES REQUESTED: Surge HELP® warranty program for coverage on motor driven appliances.

m $2,000 annual coverage $5.75 per month (+ sales tax) = $_____________

m $3,000 annual coverage $6.95 per month (+ sales tax) = $_____________

Total Monthly Lease Cost = $ __________(includes sales tax)

Customer Signature(Authorizing monthly charge on electric bill)

If your home appliances are damaged by a power surge or lightning strike, your investment will be protected. Each year there are about 25 million lightning strikes in the U.S. and Georgia ranks 8th among other states in terms of density of lightning strikes per square mile. Keep your investments safe with plans starting at $5.75 per month.

No hasslesWhy file a claim with your homeowner’s insurance and risk higher premiums? What about your deductible? With Surge HELP® you pay the same amount, regardless of claims, and there is never a deductible. Surge HELP® will even pay up to $125 in diagnostic/service fees for a valid claim and there’s no equipment to install.

More coverageMost surge protection programs exclude items such as stoves and ovens or the outside portion of your heat pump/AC and well pumps. Surge HELP® covers all of those items, giving you more protection.

Simple claims processIf you experience a power surge, filing a claim is easy – » Call 1-888-848-7893 to request a claim form » Have a repair technician diagnose your damaged item(s) » Surge HELP® will pay to repair or replace damaged items

PROTECTIONFOR YOUR VALUABLE INVESTMENTS

Surge HELP® Program Terms & ConditionsThe Surge HELP® “Home Loss Protection” Program (“Program”), covers the repair or replacement of residential electromechanical equipment and appliances damaged by an electrical surge. An “electrical surge” is defined as a short-term burst of excessive, unwanted energy (transient over-voltage) on a circuit, which if not suppressed, can accelerate wear and tear of attached electrical equipment, increasing repair frequency, repair cost and product failure.

1. The monthly program is for one single-family residence.2. Protection under the Program starts after receipt of first payment and continues thereafter so long as the customer makes timely payments. Customer payments prepay protection under the Program. Protection is suspended at the end of the prepaid period in cases of nonpayment. A customer’s account must be in good standing (current) in order for that customer to receive repair service, or replacement, under the Program. Customer may cancel participation at any time.3. The Program reimburses up to the customer-selected protection limit per year, for repair and/or replacement expenses associated with a valid claim. $5.75/month up to $2,000/year in protection; $6.95/month up to $3,000/year in protection.4. Customer is responsible for notifying the Program Claims Hotline toll-free at 888-848-7893 within seven (7) business days of damage to request a claim form. Claim form must be completed in full and mailed to the Program Claims Center with a copy of a qualified service provider’s repair invoice within thirty (30) days from the customer’s receipt of claim form. The repair invoice must be on business stationery, including the name, address and telephone number of the service provider as well as a complete description of damage and associated repair charges. A “qualified” service provider is an entity that possesses special expertise in the field of servicing or repairing residential electromechanical equipment and appliances and in fact engages in that business on a regular and ongoing basis. The Program administrator reserves the right in all cases to decide if a certain service provider is qualified.5. For an item that cannot be repaired, the Program will pay or reimburse the customer, subject to the appliance protection limit set forth in paragraph 3, the replacement value of the product. Replacement value is deemed to be the typical purchase price of the most similar product available on the market at the time of the product failure, taking into consideration the make, model and features of the item being replaced.6. All diagnostic/service fees are payable by customer directly to service provider and will be reimbursed by the Program with valid claim as long as they are usual and customary for the area, as determined by the Program. Maximum limit $125.7. All applicable payments/reimbursements from the Program to customer will be made within thirty (30) days from the Program’s receipt of a valid claim form.8. The Program excludes the following: a. Items that are damaged by reason other than an “electrical surge” b. Items not operational prior to protection term c. Items that cannot be replaced with the like kind and quality (e.g., antiques) d. Items owned by third parties e. Items not located at a covered location f. Power tools g. Additional expenses, such as a contractor’s travel charges, not covered in standard service call rate h. Expenses recoverable under product or other add-on home warranty program9. The Program administrator reserves the right to make final protection eligibility decisions.10. The Program’s liability is limited solely to the repair or replacement of appliances and electromechanical equipment damaged by electrical surges. The Program shall have no other liability for any other direct, indirect, special, incidental, consequential or other damages. The Program will not be responsible for damage caused by the customer, third parties, natural disasters, or other insurable causes. The parties agree that any claim for breach of this contract must be initiated within one (1) year from the date of accrual and that this limitations period supersedes any other limitations period that would otherwise apply. This agreement shall be interpreted under the laws of the Commonwealth of Virginia without regard to the conflicts of law principles applicable in that jurisdiction.11. The Program may be modified from time to time, within thirty (30) days written notice of material changes. The Program may also be terminated on ninety (90) days written notice.12. By enrolling, the customer represents that to the best of his/her knowledge, the equipment to be covered is functioning properly.

*The Surge HELP® Program is offered by Dominion Products and Services, Inc. (“DPS”) in cooperation with Jackson EMC and this agreement is between the customer and DPS. Surge HELP® is a registered trademark of DPS.

To file a claim under this program, please call 1-888-848-7893.

Coverage includes HVAC, ovens & stoves, and well pumps.

Frequently asked questions

Why should I purchase Surge HELP®? Can’t I just buy surge protectors?

High quality surge protectors are a good idea, in fact Jackson EMC offers them (see the order form in this brochure.) However, surge protection for motor-driven appliances, such as HVAC units, refrigerators, garage door openers and hot water heaters can be more challenging. Often these electrical outlets are difficult to access. Surge HELP® offers protection for these appliances.

How do I know you will pay the repair cost?

You can call for pre-approval once you receive a repair estimate; however, as long as the claim form is completed in full and accompanied by the proper documentation, you will receive payment. (See Terms & Conditions for complete claim process.)

How do you determine replacement cost for items that cannot be repaired?

Replacement cost is based on the typical purchase price of the most similar product available on the market today, taking into consideration the make, model and features of the item being replaced.

To order Surge HELP®, complete the enclosed order form. For more information, call Jackson EMC customer service at 1-800-462-3691.

Jackson EMC Surge ProtectionSERVICE REQUEST

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

Customer Cost

JEMC Acct # Date

Name Phone #

Address

City Zip County

SERVICES REQUESTED: Surge HELP® warranty program for coverage on motor driven appliances.

m $2,000 annual coverage $5.75 per month (+ sales tax) = $_____________

m $3,000 annual coverage $6.95 per month (+ sales tax) = $_____________

Total Monthly Lease Cost = $ __________(includes sales tax)

Customer Signature(Authorizing monthly charge on electric bill)

If your home appliances are damaged by a power surge or lightning strike, your investment will be protected. Each year there are about 25 million lightning strikes in the U.S. and Georgia ranks 8th among other states in terms of density of lightning strikes per square mile. Keep your investments safe with plans starting at $5.75 per month.

No hasslesWhy file a claim with your homeowner’s insurance and risk higher premiums? What about your deductible? With Surge HELP® you pay the same amount, regardless of claims, and there is never a deductible. Surge HELP® will even pay up to $125 in diagnostic/service fees for a valid claim and there’s no equipment to install.

More coverageMost surge protection programs exclude items such as stoves and ovens or the outside portion of your heat pump/AC and well pumps. Surge HELP® covers all of those items, giving you more protection.

Simple claims processIf you experience a power surge, filing a claim is easy – » Call 1-888-848-7893 to request a claim form » Have a repair technician diagnose your damaged item(s) » Surge HELP® will pay to repair or replace damaged items

PROTECTIONFOR YOUR VALUABLE INVESTMENTS

Surge HELP® Program Terms & ConditionsThe Surge HELP® “Home Loss Protection” Program (“Program”), covers the repair or replacement of residential electromechanical equipment and appliances damaged by an electrical surge. An “electrical surge” is defined as a short-term burst of excessive, unwanted energy (transient over-voltage) on a circuit, which if not suppressed, can accelerate wear and tear of attached electrical equipment, increasing repair frequency, repair cost and product failure.

1. The monthly program is for one single-family residence.2. Protection under the Program starts after receipt of first payment and continues thereafter so long as the customer makes timely payments. Customer payments prepay protection under the Program. Protection is suspended at the end of the prepaid period in cases of nonpayment. A customer’s account must be in good standing (current) in order for that customer to receive repair service, or replacement, under the Program. Customer may cancel participation at any time.3. The Program reimburses up to the customer-selected protection limit per year, for repair and/or replacement expenses associated with a valid claim. $5.75/month up to $2,000/year in protection; $6.95/month up to $3,000/year in protection.4. Customer is responsible for notifying the Program Claims Hotline toll-free at 888-848-7893 within seven (7) business days of damage to request a claim form. Claim form must be completed in full and mailed to the Program Claims Center with a copy of a qualified service provider’s repair invoice within thirty (30) days from the customer’s receipt of claim form. The repair invoice must be on business stationery, including the name, address and telephone number of the service provider as well as a complete description of damage and associated repair charges. A “qualified” service provider is an entity that possesses special expertise in the field of servicing or repairing residential electromechanical equipment and appliances and in fact engages in that business on a regular and ongoing basis. The Program administrator reserves the right in all cases to decide if a certain service provider is qualified.5. For an item that cannot be repaired, the Program will pay or reimburse the customer, subject to the appliance protection limit set forth in paragraph 3, the replacement value of the product. Replacement value is deemed to be the typical purchase price of the most similar product available on the market at the time of the product failure, taking into consideration the make, model and features of the item being replaced.6. All diagnostic/service fees are payable by customer directly to service provider and will be reimbursed by the Program with valid claim as long as they are usual and customary for the area, as determined by the Program. Maximum limit $125.7. All applicable payments/reimbursements from the Program to customer will be made within thirty (30) days from the Program’s receipt of a valid claim form.8. The Program excludes the following: a. Items that are damaged by reason other than an “electrical surge” b. Items not operational prior to protection term c. Items that cannot be replaced with the like kind and quality (e.g., antiques) d. Items owned by third parties e. Items not located at a covered location f. Power tools g. Additional expenses, such as a contractor’s travel charges, not covered in standard service call rate h. Expenses recoverable under product or other add-on home warranty program9. The Program administrator reserves the right to make final protection eligibility decisions.10. The Program’s liability is limited solely to the repair or replacement of appliances and electromechanical equipment damaged by electrical surges. The Program shall have no other liability for any other direct, indirect, special, incidental, consequential or other damages. The Program will not be responsible for damage caused by the customer, third parties, natural disasters, or other insurable causes. The parties agree that any claim for breach of this contract must be initiated within one (1) year from the date of accrual and that this limitations period supersedes any other limitations period that would otherwise apply. This agreement shall be interpreted under the laws of the Commonwealth of Virginia without regard to the conflicts of law principles applicable in that jurisdiction.11. The Program may be modified from time to time, within thirty (30) days written notice of material changes. The Program may also be terminated on ninety (90) days written notice.12. By enrolling, the customer represents that to the best of his/her knowledge, the equipment to be covered is functioning properly.

*The Surge HELP® Program is offered by Dominion Products and Services, Inc. (“DPS”) in cooperation with Jackson EMC and this agreement is between the customer and DPS. Surge HELP® is a registered trademark of DPS.

To file a claim under this program, please call 1-888-848-7893.

Coverage includes HVAC, ovens & stoves, and well pumps.

Frequently asked questions

Why should I purchase Surge HELP®? Can’t I just buy surge protectors?

High quality surge protectors are a good idea, in fact Jackson EMC offers them (see the order form in this brochure.) However, surge protection for motor-driven appliances, such as HVAC units, refrigerators, garage door openers and hot water heaters can be more challenging. Often these electrical outlets are difficult to access. Surge HELP® offers protection for these appliances.

How do I know you will pay the repair cost?

You can call for pre-approval once you receive a repair estimate; however, as long as the claim form is completed in full and accompanied by the proper documentation, you will receive payment. (See Terms & Conditions for complete claim process.)

How do you determine replacement cost for items that cannot be repaired?

Replacement cost is based on the typical purchase price of the most similar product available on the market today, taking into consideration the make, model and features of the item being replaced.

To order Surge HELP®, complete the enclosed order form. For more information, call Jackson EMC customer service at 1-800-462-3691.

Jackson EMC Surge ProtectionSERVICE REQUEST

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

Customer Cost

JEMC Acct # Date

Name Phone #

Address

City Zip County

SERVICES REQUESTED: Surge HELP® warranty program for coverage on motor driven appliances.

m $2,000 annual coverage $5.75 per month (+ sales tax) = $_____________

m $3,000 annual coverage $6.95 per month (+ sales tax) = $_____________

Total Monthly Lease Cost = $ __________(includes sales tax)

Customer Signature(Authorizing monthly charge on electric bill)

If your home appliances are damaged by a power surge or lightning strike, your investment will be protected. Each year there are about 25 million lightning strikes in the U.S. and Georgia ranks 8th among other states in terms of density of lightning strikes per square mile. Keep your investments safe with plans starting at $5.75 per month.

No hasslesWhy file a claim with your homeowner’s insurance and risk higher premiums? What about your deductible? With Surge HELP® you pay the same amount, regardless of claims, and there is never a deductible. Surge HELP® will even pay up to $125 in diagnostic/service fees for a valid claim and there’s no equipment to install.

More coverageMost surge protection programs exclude items such as stoves and ovens or the outside portion of your heat pump/AC and well pumps. Surge HELP® covers all of those items, giving you more protection.

Simple claims processIf you experience a power surge, filing a claim is easy – » Call 1-888-848-7893 to request a claim form » Have a repair technician diagnose your damaged item(s) » Surge HELP® will pay to repair or replace damaged items

PROTECTIONFOR YOUR VALUABLE INVESTMENTS

Surge HELP® Program Terms & ConditionsThe Surge HELP® “Home Loss Protection” Program (“Program”), covers the repair or replacement of residential electromechanical equipment and appliances damaged by an electrical surge. An “electrical surge” is defined as a short-term burst of excessive, unwanted energy (transient over-voltage) on a circuit, which if not suppressed, can accelerate wear and tear of attached electrical equipment, increasing repair frequency, repair cost and product failure.

1. The monthly program is for one single-family residence.2. Protection under the Program starts after receipt of first payment and continues thereafter so long as the customer makes timely payments. Customer payments prepay protection under the Program. Protection is suspended at the end of the prepaid period in cases of nonpayment. A customer’s account must be in good standing (current) in order for that customer to receive repair service, or replacement, under the Program. Customer may cancel participation at any time.3. The Program reimburses up to the customer-selected protection limit per year, for repair and/or replacement expenses associated with a valid claim. $5.75/month up to $2,000/year in protection; $6.95/month up to $3,000/year in protection.4. Customer is responsible for notifying the Program Claims Hotline toll-free at 888-848-7893 within seven (7) business days of damage to request a claim form. Claim form must be completed in full and mailed to the Program Claims Center with a copy of a qualified service provider’s repair invoice within thirty (30) days from the customer’s receipt of claim form. The repair invoice must be on business stationery, including the name, address and telephone number of the service provider as well as a complete description of damage and associated repair charges. A “qualified” service provider is an entity that possesses special expertise in the field of servicing or repairing residential electromechanical equipment and appliances and in fact engages in that business on a regular and ongoing basis. The Program administrator reserves the right in all cases to decide if a certain service provider is qualified.5. For an item that cannot be repaired, the Program will pay or reimburse the customer, subject to the appliance protection limit set forth in paragraph 3, the replacement value of the product. Replacement value is deemed to be the typical purchase price of the most similar product available on the market at the time of the product failure, taking into consideration the make, model and features of the item being replaced.6. All diagnostic/service fees are payable by customer directly to service provider and will be reimbursed by the Program with valid claim as long as they are usual and customary for the area, as determined by the Program. Maximum limit $125.7. All applicable payments/reimbursements from the Program to customer will be made within thirty (30) days from the Program’s receipt of a valid claim form.8. The Program excludes the following: a. Items that are damaged by reason other than an “electrical surge” b. Items not operational prior to protection term c. Items that cannot be replaced with the like kind and quality (e.g., antiques) d. Items owned by third parties e. Items not located at a covered location f. Power tools g. Additional expenses, such as a contractor’s travel charges, not covered in standard service call rate h. Expenses recoverable under product or other add-on home warranty program9. The Program administrator reserves the right to make final protection eligibility decisions.10. The Program’s liability is limited solely to the repair or replacement of appliances and electromechanical equipment damaged by electrical surges. The Program shall have no other liability for any other direct, indirect, special, incidental, consequential or other damages. The Program will not be responsible for damage caused by the customer, third parties, natural disasters, or other insurable causes. The parties agree that any claim for breach of this contract must be initiated within one (1) year from the date of accrual and that this limitations period supersedes any other limitations period that would otherwise apply. This agreement shall be interpreted under the laws of the Commonwealth of Virginia without regard to the conflicts of law principles applicable in that jurisdiction.11. The Program may be modified from time to time, within thirty (30) days written notice of material changes. The Program may also be terminated on ninety (90) days written notice.12. By enrolling, the customer represents that to the best of his/her knowledge, the equipment to be covered is functioning properly.

*The Surge HELP® Program is offered by Dominion Products and Services, Inc. (“DPS”) in cooperation with Jackson EMC and this agreement is between the customer and DPS. Surge HELP® is a registered trademark of DPS.

To file a claim under this program, please call 1-888-848-7893.

Coverage includes HVAC, ovens & stoves, and well pumps.

Frequently asked questions

Why should I purchase Surge HELP®? Can’t I just buy surge protectors?

High quality surge protectors are a good idea, in fact Jackson EMC offers them (see the order form in this brochure.) However, surge protection for motor-driven appliances, such as HVAC units, refrigerators, garage door openers and hot water heaters can be more challenging. Often these electrical outlets are difficult to access. Surge HELP® offers protection for these appliances.

How do I know you will pay the repair cost?

You can call for pre-approval once you receive a repair estimate; however, as long as the claim form is completed in full and accompanied by the proper documentation, you will receive payment. (See Terms & Conditions for complete claim process.)

How do you determine replacement cost for items that cannot be repaired?

Replacement cost is based on the typical purchase price of the most similar product available on the market today, taking into consideration the make, model and features of the item being replaced.

To order Surge HELP®, complete the enclosed order form. For more information, call Jackson EMC customer service at 1-800-462-3691.

Jackson EMC Surge ProtectionSERVICE REQUEST

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

Customer Cost

JEMC Acct # Date

Name Phone #

Address

City Zip County

SERVICES REQUESTED: Surge HELP® warranty program for coverage on motor driven appliances.

m $2,000 annual coverage $5.75 per month (+ sales tax) = $_____________

m $3,000 annual coverage $6.95 per month (+ sales tax) = $_____________

Total Monthly Lease Cost = $ __________(includes sales tax)

Customer Signature(Authorizing monthly charge on electric bill)

If your home appliances are damaged by a power surge or lightning strike, your investment will be protected. Each year there are about 25 million lightning strikes in the U.S. and Georgia ranks 8th among other states in terms of density of lightning strikes per square mile. Keep your investments safe with plans starting at $5.75 per month.

No hasslesWhy file a claim with your homeowner’s insurance and risk higher premiums? What about your deductible? With Surge HELP® you pay the same amount, regardless of claims, and there is never a deductible. Surge HELP® will even pay up to $125 in diagnostic/service fees for a valid claim and there’s no equipment to install.

More coverageMost surge protection programs exclude items such as stoves and ovens or the outside portion of your heat pump/AC and well pumps. Surge HELP® covers all of those items, giving you more protection.

Simple claims processIf you experience a power surge, filing a claim is easy – » Call 1-888-848-7893 to request a claim form » Have a repair technician diagnose your damaged item(s) » Surge HELP® will pay to repair or replace damaged items

PROTECTIONFOR YOUR VALUABLE INVESTMENTS

Surge HELP® Program Terms & ConditionsThe Surge HELP® “Home Loss Protection” Program (“Program”), covers the repair or replacement of residential electromechanical equipment and appliances damaged by an electrical surge. An “electrical surge” is defined as a short-term burst of excessive, unwanted energy (transient over-voltage) on a circuit, which if not suppressed, can accelerate wear and tear of attached electrical equipment, increasing repair frequency, repair cost and product failure.

1. The monthly program is for one single-family residence.2. Protection under the Program starts after receipt of first payment and continues thereafter so long as the customer makes timely payments. Customer payments prepay protection under the Program. Protection is suspended at the end of the prepaid period in cases of nonpayment. A customer’s account must be in good standing (current) in order for that customer to receive repair service, or replacement, under the Program. Customer may cancel participation at any time.3. The Program reimburses up to the customer-selected protection limit per year, for repair and/or replacement expenses associated with a valid claim. $5.75/month up to $2,000/year in protection; $6.95/month up to $3,000/year in protection.4. Customer is responsible for notifying the Program Claims Hotline toll-free at 888-848-7893 within seven (7) business days of damage to request a claim form. Claim form must be completed in full and mailed to the Program Claims Center with a copy of a qualified service provider’s repair invoice within thirty (30) days from the customer’s receipt of claim form. The repair invoice must be on business stationery, including the name, address and telephone number of the service provider as well as a complete description of damage and associated repair charges. A “qualified” service provider is an entity that possesses special expertise in the field of servicing or repairing residential electromechanical equipment and appliances and in fact engages in that business on a regular and ongoing basis. The Program administrator reserves the right in all cases to decide if a certain service provider is qualified.5. For an item that cannot be repaired, the Program will pay or reimburse the customer, subject to the appliance protection limit set forth in paragraph 3, the replacement value of the product. Replacement value is deemed to be the typical purchase price of the most similar product available on the market at the time of the product failure, taking into consideration the make, model and features of the item being replaced.6. All diagnostic/service fees are payable by customer directly to service provider and will be reimbursed by the Program with valid claim as long as they are usual and customary for the area, as determined by the Program. Maximum limit $125.7. All applicable payments/reimbursements from the Program to customer will be made within thirty (30) days from the Program’s receipt of a valid claim form.8. The Program excludes the following: a. Items that are damaged by reason other than an “electrical surge” b. Items not operational prior to protection term c. Items that cannot be replaced with the like kind and quality (e.g., antiques) d. Items owned by third parties e. Items not located at a covered location f. Power tools g. Additional expenses, such as a contractor’s travel charges, not covered in standard service call rate h. Expenses recoverable under product or other add-on home warranty program9. The Program administrator reserves the right to make final protection eligibility decisions.10. The Program’s liability is limited solely to the repair or replacement of appliances and electromechanical equipment damaged by electrical surges. The Program shall have no other liability for any other direct, indirect, special, incidental, consequential or other damages. The Program will not be responsible for damage caused by the customer, third parties, natural disasters, or other insurable causes. The parties agree that any claim for breach of this contract must be initiated within one (1) year from the date of accrual and that this limitations period supersedes any other limitations period that would otherwise apply. This agreement shall be interpreted under the laws of the Commonwealth of Virginia without regard to the conflicts of law principles applicable in that jurisdiction.11. The Program may be modified from time to time, within thirty (30) days written notice of material changes. The Program may also be terminated on ninety (90) days written notice.12. By enrolling, the customer represents that to the best of his/her knowledge, the equipment to be covered is functioning properly.

*The Surge HELP® Program is offered by Dominion Products and Services, Inc. (“DPS”) in cooperation with Jackson EMC and this agreement is between the customer and DPS. Surge HELP® is a registered trademark of DPS.

To file a claim under this program, please call 1-888-848-7893.

Coverage includes HVAC, ovens & stoves, and well pumps.

Frequently asked questions

Why should I purchase Surge HELP®? Can’t I just buy surge protectors?

High quality surge protectors are a good idea, in fact Jackson EMC offers them (see the order form in this brochure.) However, surge protection for motor-driven appliances, such as HVAC units, refrigerators, garage door openers and hot water heaters can be more challenging. Often these electrical outlets are difficult to access. Surge HELP® offers protection for these appliances.

How do I know you will pay the repair cost?

You can call for pre-approval once you receive a repair estimate; however, as long as the claim form is completed in full and accompanied by the proper documentation, you will receive payment. (See Terms & Conditions for complete claim process.)

How do you determine replacement cost for items that cannot be repaired?

Replacement cost is based on the typical purchase price of the most similar product available on the market today, taking into consideration the make, model and features of the item being replaced.

To order Surge HELP®, complete the enclosed order form. For more information, call Jackson EMC customer service at 1-800-462-3691.

Jackson EMC Surge ProtectionSERVICE REQUEST

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

The Power to Improve Your Life

Never worry aboutexpensive electrical surge

damage again

SURGEPROTECTION

PROGRAM

Model 1 To protect most electronics, choose the single plug (Model 1). It is perfect for stereo systems, CD players, microwave ovens, or any other devices without additional telephone or cable TV connections.

Model 2To protect electronics with phone connections and DSL, choose Model 2. This single-plug model is great for phones, answering machines, computers and fax machines.

Model 3Televisions and compatible devices, such as cable TV receivers, game systems, DVD and Blu-ray players, are protected with Model 3.

Model 4For protection of multiple electronics, including satellite dish protection, use the 8-plug surge protection model with modem and coaxial (Model 4). This model protects phones, computers, cable TV receivers and satellite TV receivers.

850 Commerce Road | P.O. Box 38 | Jefferson, GA 30549

www.jacksonemc.com

10/2014

ORDER FORMPlug-in Protector Devices For ElectronicsModel # Qty. Price Total

1-SOPPS ____ $17 ea. $_________Single Outlet

2-SOPPT ____ $17 ea. $_________Single Outlet with Modem

3-SOPPC ____ $17 ea. $_________Single Outlet with Coaxial

4-1500DRJ ____ $88 ea. $_________8-Outlet w/Modem and Coaxial

Subtotal $_________

Sales Tax $_________

TOTAL COST $_________

Ordering Information

Ship To _________________________________________________

Address _________________________________________________

City _______________________ State _______ Zip ____________

Daytime Phone ___________________________________________

Account # ______________________________________________

Method of Payment (*Subject to approval)

Cash Check (Check Enclosed)

Charge total amount on next bill (Jackson EMC customers/members only)*

Charge total amount over 3 months (Jackson EMC customers/members only)*

Discover/VISA/MasterCard

For payment by credit card, please provide the information below. There is a $3.50 charge for credit card transactions.

Discover VISA MasterCard

Credit Card Number

Expiration Date

Signature ________________________________________________

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

m m m

m

m

m

m m

MONTH YEAR

With Jackson EMC’s Surge Protection for Electronics, your valuable electronics are protected against damage due to lightning or power surges. These devices are designed to keep lightning from ever reaching your computer, TV, DVD and Blu-ray players, or any electronic device plugged in. If they don’t, your electronics will be replaced or repaired, free of charge! **

**Warranty Coverage (Residential only, not commercial)PSP TVSS are warrantied for life. If a surge should pass through a PSP TVSS and the TVSS fails, causing consequential damage to the equipment correctly connected to it, PSP will pay up to $25,000 per occurrence for repair or replacement with a $6 million limit per location. PSP Products, Inc., handles claims.

For more information, visit jacksonemc.com/surge or call Jackson EMC customer service at 1-800-462-3691.

PROTECTYOUR ELECTRONICSFROM POWER SURGES!

The Power to Improve Your Life

Never worry aboutexpensive electrical surge

damage again

SURGEPROTECTION

PROGRAM

Model 1 To protect most electronics, choose the single plug (Model 1). It is perfect for stereo systems, CD players, microwave ovens, or any other devices without additional telephone or cable TV connections.

Model 2To protect electronics with phone connections and DSL, choose Model 2. This single-plug model is great for phones, answering machines, computers and fax machines.

Model 3Televisions and compatible devices, such as cable TV receivers, game systems, DVD and Blu-ray players, are protected with Model 3.

Model 4For protection of multiple electronics, including satellite dish protection, use the 8-plug surge protection model with modem and coaxial (Model 4). This model protects phones, computers, cable TV receivers and satellite TV receivers.

850 Commerce Road | P.O. Box 38 | Jefferson, GA 30549

www.jacksonemc.com

10/2014

ORDER FORMPlug-in Protector Devices For ElectronicsModel # Qty. Price Total

1-SOPPS ____ $17 ea. $_________Single Outlet

2-SOPPT ____ $17 ea. $_________Single Outlet with Modem

3-SOPPC ____ $17 ea. $_________Single Outlet with Coaxial

4-1500DRJ ____ $88 ea. $_________8-Outlet w/Modem and Coaxial

Subtotal $_________

Sales Tax $_________

TOTAL COST $_________

Ordering Information

Ship To _________________________________________________

Address _________________________________________________

City _______________________ State _______ Zip ____________

Daytime Phone ___________________________________________

Account # ______________________________________________

Method of Payment (*Subject to approval)

Cash Check (Check Enclosed)

Charge total amount on next bill (Jackson EMC customers/members only)*

Charge total amount over 3 months (Jackson EMC customers/members only)*

Discover/VISA/MasterCard

For payment by credit card, please provide the information below. There is a $3.50 charge for credit card transactions.

Discover VISA MasterCard

Credit Card Number

Expiration Date

Signature ________________________________________________

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

m m m

m

m

m

m m

MONTH YEAR

With Jackson EMC’s Surge Protection for Electronics, your valuable electronics are protected against damage due to lightning or power surges. These devices are designed to keep lightning from ever reaching your computer, TV, DVD and Blu-ray players, or any electronic device plugged in. If they don’t, your electronics will be replaced or repaired, free of charge! **

**Warranty Coverage (Residential only, not commercial)PSP TVSS are warrantied for life. If a surge should pass through a PSP TVSS and the TVSS fails, causing consequential damage to the equipment correctly connected to it, PSP will pay up to $25,000 per occurrence for repair or replacement with a $6 million limit per location. PSP Products, Inc., handles claims.

For more information, visit jacksonemc.com/surge or call Jackson EMC customer service at 1-800-462-3691.

PROTECTYOUR ELECTRONICSFROM POWER SURGES!

The Power to Improve Your Life

Never worry aboutexpensive electrical surge

damage again

SURGEPROTECTION

PROGRAM

Model 1 To protect most electronics, choose the single plug (Model 1). It is perfect for stereo systems, CD players, microwave ovens, or any other devices without additional telephone or cable TV connections.

Model 2To protect electronics with phone connections and DSL, choose Model 2. This single-plug model is great for phones, answering machines, computers and fax machines.

Model 3Televisions and compatible devices, such as cable TV receivers, game systems, DVD and Blu-ray players, are protected with Model 3.

Model 4For protection of multiple electronics, including satellite dish protection, use the 8-plug surge protection model with modem and coaxial (Model 4). This model protects phones, computers, cable TV receivers and satellite TV receivers.

850 Commerce Road | P.O. Box 38 | Jefferson, GA 30549

www.jacksonemc.com

10/2014

ORDER FORMPlug-in Protector Devices For ElectronicsModel # Qty. Price Total

1-SOPPS ____ $17 ea. $_________Single Outlet

2-SOPPT ____ $17 ea. $_________Single Outlet with Modem

3-SOPPC ____ $17 ea. $_________Single Outlet with Coaxial

4-1500DRJ ____ $88 ea. $_________8-Outlet w/Modem and Coaxial

Subtotal $_________

Sales Tax $_________

TOTAL COST $_________

Ordering Information

Ship To _________________________________________________

Address _________________________________________________

City _______________________ State _______ Zip ____________

Daytime Phone ___________________________________________

Account # ______________________________________________

Method of Payment (*Subject to approval)

Cash Check (Check Enclosed)

Charge total amount on next bill (Jackson EMC customers/members only)*

Charge total amount over 3 months (Jackson EMC customers/members only)*

Discover/VISA/MasterCard

For payment by credit card, please provide the information below. There is a $3.50 charge for credit card transactions.

Discover VISA MasterCard

Credit Card Number

Expiration Date

Signature ________________________________________________

MAIL TO: Jackson EMC / P.O. Box 38 / Jefferson, GA 30549

Ordering information available online at jacksonemc.com/surge

m m m

m

m

m

m m

MONTH YEAR

With Jackson EMC’s Surge Protection for Electronics, your valuable electronics are protected against damage due to lightning or power surges. These devices are designed to keep lightning from ever reaching your computer, TV, DVD and Blu-ray players, or any electronic device plugged in. If they don’t, your electronics will be replaced or repaired, free of charge! **

**Warranty Coverage (Residential only, not commercial)PSP TVSS are warrantied for life. If a surge should pass through a PSP TVSS and the TVSS fails, causing consequential damage to the equipment correctly connected to it, PSP will pay up to $25,000 per occurrence for repair or replacement with a $6 million limit per location. PSP Products, Inc., handles claims.

For more information, visit jacksonemc.com/surge or call Jackson EMC customer service at 1-800-462-3691.

PROTECTYOUR ELECTRONICSFROM POWER SURGES!