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Capital Credit Application

Name Change Due to Marriage

Capital Credit Application for Name Change Due to Marriage

I hereby request, because of my marriage, that my membership be transferred on the books of Whitewater Valley REMC together with all rights and obligations therewith, to my new legal name.

Original Name of Member
Original Name of Member
First
Last
New Legal Name
New Legal Name
First
Last
Service Address
Service Address
City
State/Province
Zip/Postal
Mailing Address
Mailing Address
City
State/Province
Zip/Postal