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Request to Authorize User on Account

Date

Email

Member's Name

Last 4 of SSN

Authorized User(s):

Name

Phone Number

Mailing Address

Mailing Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Name

Phone Number

Mailing Address

Mailing Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Additional Names

Accounts Included in this Authorization

All Current Accounts (list below)

All Current and Future Accounts (list below)

Specific Account Numbers (list below)

Account Numbers

Type of Authorization/Access

Balance Inquires & Payments

Change or Adjust Budget Payment Plan

Letter of Credit

Sign for Payment Arrangements

Copy of Bill & Delinquent Notice

Payment History

Capital Credit Inquires

Consumption History

Add Name to Bill (Account Level)

Member Signature

Sign above

I am acting on behalf of the member as Power of Attorney

Last Name

First Name

Please provide Power of Attorney Documentation

One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Power of Attorney Signature

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Contact Information

Sierra Electric Cooperative
Office Phone Number: 575-744-5231
Office Fax Number: 575-744-5819
After Hours Emergency Outage Reporting (Toll-free New Mexico): 1-888-336-3380
Office Hours: 8 a.m. - 5 p.m.

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