(Other than the Member(s))

The Cooperative takes seriously the protection of member information and follow the FTC guidelines to ensure proper protocol is in place.

By signing the below, I, the Member understand that I am allowing all parties listed below access to the electric account on this form. I further understand that the parties listed will be able to gain access to account information and make payment arrangements but are not responsible for any debt owed to the Cooperative nor will they have the authority to request a change in the status of electric service.
Signature *