Authorization Agreement for Automatic Transfer

This form allows property owners to request that billing responsibility automatically transfer back to their name whenever a tenant requests a disconnection of electric service.

Please fill in each required field* and press SUBMIT. You will receive a confirmation message when complete.

Claverack Rural Electric Cooperative, Inc. offers this electronic form to members of the cooperative for their convenience. A hard copy of this form is available for completion at our main office or can be requested by mail.

Authorization Agreement for Automatic Transfer

Authorization Agreement For Automatic Transfer

Owner's Name:

Owner's Phone Number

Please list all 911 property addresses to be covered under this agreement.

I authorize automatic transfer as follows: As the owner of the properties listed above, I authorize Claverack REC to automatically transfer billing responsibility for electric service into my name when a tenant requests disconnection of same. I understand that this does not include disconnection for non-payment situations. This agreement will remain in effect until I am no longer the property owner. I will notify the cooperative at least 30 days in advance if my ownership of any property ends.

Please read

Authorization agreement details above.

Electronic Signature:

Type your name as you would sign it.

FOR OFFICE USE ONLY

Owner's Capital Credit Number: