Community Cares Participation Form

By submitting this form, you are joining the Community Cares program. This program authorizes Riverland Energy Cooperative to round up your bill each month to the next whole dollar, and donate the rounded-up amount to the Riverland Community Cares Foundation. If you have questions about the program, please call the co-op at 800-411-9115.

First Name

Last Name

Phone Number

Address

City/Town

State/Province

ZIP/Postal Code

Account Number

Agreement

I understand that by enrolling in this program, I am giving Riverland Energy Cooperative permission to round my bill up each month to the nearest whole dollar and donate the rounded-up amount to the Riverland Community Cares Foundation. I also understand that the Foundation will administer these funds.