Business Account Access Authorization
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Authorized Individual Name
Title
Check One
The authorized individuals listed may inquire about the account and make changes to the service. Although one vote is allowed per membership in a cooperative election, any of the authorized individuals may cast the vote.
Revoke access to the electric account(s) for the authorized designee(s) listed above
Accounts included in this authorization
All current accounts and any future accounts.
Specified account number(s) only.
Account Number(s)
Member Name
Date
Customer #
FED ID #
Email