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Name Change Due to Marriage Form

This document is to certify that I am a member of Coast Electric Power Association and I have recently married. I request Coast Electric to change the name of my electric account:

Account Number(Required)

From:

Name(Required)

First Last

To:

Name(Required)

First Last

and I do hereby transfer the membership fee, accrued capital credits, consumer deposit and interest to my married name.

Date(Required)

Name(Required)

First Last

Marriage Certificate(Required)

Max. file size: 50 MB.

Please upload a copy of the marriage certificate.

Please complete information below:

Member Home Phone(Required)

Member Cell Phone(Required)

Member Email(Required)

Relative's Name(Required)

First Last

Relative's Phone(Required)

Spouse Information:

Spouse Name(Required)

First Last

Spouse Home Phone(Required)

Spouse Cell Phone(Required)

Spouse Email(Required)

Spouse Relative's Name(Required)

First Last

Spouse Relative's Phone(Required)

This institution is an equal opportunity provider and employer.