Authorization to Transact

Primary Member

Assigning a Secondary Contact to a Victory Electric Account

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Account Number

Driver's license number

Photo of Primary Driver's License

One file only.
100 MB limit.
Allowed types: jpg, png, tif, pict, psd, html, pdf, doc, docx.

Secondary Accountholder

Name

Relationship to primary

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Social Security number & Driver's license number

Photo of Secondary Driver's License

One file only.
100 MB limit.
Allowed types: jpg, png, tif, pict, psd, html, pdf, doc, docx.

Both the Primary Member and the Secondary Accountholder Acknowledges

The secondary account holder has permission to obtain billing and payment history, inquire about the bill due date(s) and total amount due, make payments, set up payment arrangements, and make account changes such as mailing address, phone number and email address.
The primary member holds the cooperative membership. It does NOT become a joint membership. The secondary accountholder does not have votingrights in the cooperative.
The secondary accounthodler assume and shares liability for any debt incurred on the account.
This authorization is in effect until Victory Electric is otherwise notified by the primary member.

Primary member please sign below.

Secondary Member Signature

Secondary member signature please sign above.