Move-in or Move-Out transfer of Electric Utility into Tenant Name

or Out of Tenant Name - Verification by Owner/Agent

Tenant Name:  ___________________________________________________

Physical Address _________________________________________________

Mail Address   PO Box _____________________________________________

Telephone number 835-______  And Cell number ________________________

 

Per request of Owner/signature:  _________________________

Per request of Tenant/signature:  _________________________

This section to be completed by Copper Valley Electric Assoc. Representative ONLY

As of ________________________________________ the above named Tenant has completed the necessary requirements, and the Electric Utility at the above address & unit number is now transferred/billled to his/her name.

We agree to use the meter read as supplied by the owner which is _________

as of _______________________. ( ____ move in - or _____ move out)

Print Name:___________________________________________________

 

Signature of CVEA Rep _____________________________________________________