Authorized Contact Agreement | Riverland Energy Cooperative

authorized contact agreement

An “Authorized Contact” is a person you allow Riverland Energy Cooperative to give your account information to. To add an Authorized Contact(s), please fill in all the data included on this form, sign at the bottom, and hit submit.

Name as it appears on account

Account Number

First Authorized Contact Information

authorized contact name

authorized contact address

city

state

zip code

phone number

date of birth

authorization message

I authorize the above listed person(s) to have access to all information contained on my account which will include, but not be limited to, balances, payments, addresses and current or historical use information. The person(s) above are authorized to receive this information via phone, mail, or the SmartHub website.

signature of current member

Sign above