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Name Change Due to Divorce Form

"*" indicates required fields

This document is to certify that I,


,am a member of Coast Electric (Print Name) Power Association, Member #:

and I have recently (Member Number) divorced. I request Coast Electric to change the name of my electric account from:

From Name*


To Name*
Max. file size: 50 MB.
Please upload a copy of the Divorce Decree.

Please complete information below:

This institution is an equal opportunity provider and employer.

This field is for validation purposes and should be left unchanged.
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