My Home 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)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name(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.