Name Change Form

Name Change

Form for member’s who are needing to change their last name only on an account.

Account Number(Required)

Does your mailing address need to be updated?(Required)

Yes

Mailing Address(Required)

Mailing address for bill statement Address 2 City State/Province ZIP/Postal Code

Member Information

Name Currently Showing on Account(Required)

First Last

Name needing to be Changed to:(Required)

First Last

Social Security Number(Required)

Please enter a number greater than or equal to 0.

Email Address(Required)

Home/Primary Phone(Required)

Cell Phone(Required)

Drivers License or ID(Required)

Accepted file types: gif, jpg, png, svg, jpeg, Max. file size: 20 MB.

Name on DL/ID must match what you are changing the name on the account to.

Member Signature(Required)

Date(Required)

Time

Notes

Terms of Agreement

Co-Applicant agrees to become a member and comply with and be bound by the Cooperative’s articles of incorporation, bylaws and tariffs, including rate schedules and service rules. Rates may be changed by the Cooperative’s board of directors in the manner provided by law. Member shall grant to Cooperative written easement(s) satisfactory to the Cooperative that are necessary for a cooperative purpose including providing electric service to Member or other members or applicants for the Cooperative’s service. Access is required for inspection and line maintenance purposes. Member/Consumer agrees to provide access for all utility purposes. Member/Consumer agrees to allow Fannin Electric Co-op. to install a lock if there is or ever shall be a locked gate at this location.

All Applicants subject to ID verification and credit report review. False, inaccurate or incomplete information will invalidate the application until discrepancies are resolved.

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Name Change Form

Name Change

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