subject_line
301G- Update Membership Information
Current Member Information
Information must match current membership records
Account Number
*
First Name
*
Middle Initial
Last Name
*
Date of Birth
*
+
Social Security #
*
Phone Number
*
Type of Phone
*
Cell Phone
Home Phone
Additional Phone Number
Type of Phone
Cell Phone
Home Phone
Service Address
*
City
*
State
*
Zip
*
Mailing Address (if different from above)
City
Zip
State
Check each section you wish to have updated in your membership information.
Member Name Change Only
Fill out this section
only
if you wish to update this in your membership information.
Member Name Change Only
Yes
Member First Name
*
Middle Initial
Last Name
*
Update Contact information
Fill out this section
only
if you wish to update this in your membership information.
Update Contact Information (mailing address, phone number, email address, etc.)
Yes
New Mailing Address
City
State
Zip
Phone Number
Type of Phone
Cell Phone
Home Phone
Business
Additional Phone Number
Type of Phone
Cell Phone
Home Phone
Business
Additional Phone Number
Type of Phone
Cell Phone
Home Phone
Business
New Email Address
Other
Add New Member to Account (this will change your account from Single to Joint)
Fill out this section
only
if you wish to update this in your membership information.
Add New Member to Account (this will change your account from Single to Joint)
Yes
New Joint Member Information:
First Name
*
Middle Initial
Last Name
*
Date of Birth
*
+
Social Security #
*
Phone Number
*
Type of Phone
*
Cell Phone
Home Phone
Additional Phone Number
Type of Phone
Cell Phone
Home Phone
Business
Joint Member's Email Address
By initialing below, as the current single member authorize Todd-Wadena Electric Cooperative to add the above named to all membership, capital credits, and accounts receivable records and understand the account will be transferred to a Join account.
*
Change Membership Name to a Trust
Fill out this section
only
if you wish to update this in your membership information.
Change Membership Name to a Trust
Yes
New Customer #
Trust Name
*
Federal ID #
*
A copy of the Certificate of Trust showing the Grantor(s) and Trustee(s) for the Trust is required.
*
By initialing below, I authorize Todd-Wadena Electric Cooperative to change the name on the membership, capital credits and accounts receivable records to the above Trust name.
*
Required Signature(s)
Member Signature
*
clear
Date
*
+
Co-Member Signature
*
clear
Date
+
This institution is an equal opportunity provider and employer.