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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

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Power of Attorney Signature

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Statement of Non-Discrimination

In accordance with Federal civil rights laws and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

1. Mail: US Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410

2. Fax: (202) 690-7442; or

3. Email: program.intake@usda.gov

Sierra Electric Cooperative, Inc. is an Equal Opportunity Provider and Employer

©2023 Sierra Electric Cooperative. A Touchstone Energy Cooperative.

Consumer-Member Info
Outage Center
- Reporting an Outage
- Outage Safety & Tips
Service
Co-op Community
- Youth & Education Programs
Announcements & Forms