Name on account
This document is to give authorization to the person listed below to be able to receive information about my account with West River Electric. This will include usage amounts, dollar balances, and make payment arrangements to the account. This person(s) will NOT have the authority to make changes to the account.
This authorization is valid until it is revoked by the member.
Name or names to authorize.
By Checking the AGREE box, I acknowledge that I am allowing the person(s) listed above to be able to receive information about my account with West River Electric, and by submitting this document electronically I understand that this is the legal equivalent of having placed my handwritten signature on the document.
Do Not Fill This Out