Unclaimed Capital Credits Payment Request

Unclaimed Capital Credits Payment Request Form

Company

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

This form is being completed by:(Required)

Member | Prior Member | Legal Representative

Wasco Electric MSR

Applicant

Name of Person Submitting Request(Required)

First Last

Name of Individual(s) Inquiring About(Required)

First Last

Relationship to Individual(s)Inquiring About

Account Number (if known)

Current Mailing Address (if different from Service Address)

Street Address Address Line 2 City State ZIP Code

Service Address (physical address where service was recieved)

Street Address Address Line 2 City State ZIP Code

Phone

Co-Applicant

Name

First Last

Current Mailing Address (if different from Service Address)

Street Address Address Line 2 City State ZIP Code

Phone

Business

Legal Business Name Inquiring About

Attach a copy of valid Government issued photo ID for each signer.(Required)

Drop files here or

Max. file size: 2 GB.

Government ID Verification:

A copy of the Member's valid government-issued photo ID is not submitted through this form. The Member will provide a copy of their ID separately (by mail, email, or in person) before payment can be processed.

MSR Name(Required)

Unclaimed Capital Credits Payment Request