UEC Transfer Service Request
Requested Date to Transfer Service
*
Date
Are you a current United Electric Cooperative Member?
*
Yes
No
If not a current member, please fill out our
membership application here.
Name
*
First Name
Last Name
Service Address (address you are wanting service in your name)
*
Street Address
City
State
Zip
Mailing Address
*
Street Address
City
State
Zip
E-mail
*
example@example.com
Phone Number
*
Notes to Member Services Representative.
*
Signature
*
Clear
Please verify that you are human
*
