Third Party Agreement   

Occasionally you may be ill, incapacitated or away from home and unable to pay your electric bill.  As a result, your electric utility service may be disconnected.
To protect you, the Cooperative offers the opportunity for you to designate a third party, such as a relative, or a friend, to receive notice of any disconnect.  The Third Party Agreement does not make the third party responsible for paying any part of the bill.
By completing this form and returning it to the Cooperative, you request that any notice of disconnection of your Cooperative utility service for nonpayment also be mailed to the person or agency named below:

 

 

 

  

Customer Name

  

Third Party Name
     
Account Number   Address
     
Customer Signature   Signature of Third Party
     

Date                    Phone Number

  

Date                     Phone Number

 

Mail this form to:       

Steuben Rural Electric Cooperative, Inc.
Billing Department
9 Wilson Avenue
Bath, New York  14810

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