SMC Opt-Out form 3

Account Number

I do not wish to participate in the Southwest Members Care program.

This is a Residential account.

This is a Business/Commercial Account.

Business/Company Name (for commercial accounts only)

Last Name of account holder

First Name of account holder

Middle Initial

Service Address

City

E-mail Address

Confirm email

I would like my phone numbers updated on my Southwest TN EMC account.

Cell Phone #1

Cell Phone #2

Landline