Other Forms

Third Party Notification Form This is a service that gives YVEA members the opportunity to designate a third-party to whom notices of discontinuance of service for non-payment will be delivered.

Auto Transfer Form This is a service that requests YVEA to leave the electric service to the service location connected to an owner/landlords name in the event that anyone other than the owner/landlord orders it disconnected.

Automatic Payment Authorization

First

Middle

Last

Email

Daytime Phone Number

YVEA Account Number

Address

City/Town

State/Province

ZIP/Postal Code

Automatic Payment Authorization

Banking Information

Account Type

Checking

Savings

Bank Name

Bank Routing Number

Bank Routing Number (Confirm)

Bank Account Number

Bank Account Number (Confirm)

I agree to the terms of service.

I authorize Yampa Valley Electric Association (YVEA) to process entries to my financial account in the amount of my current monthly electric billing obligation. This authority will remain in effect until written notice is given by either party to terminate the authorization. Notification of cancellation shall be effective upon receipt of the written notice.
I agree that YVEA is authorized to delete and change information regarding my financial institutuion after verification of my personal information.
Should an erroneous debit be made to my account, I authorize YVEA and my financial institution to stop payment, reverse the entry, or make any adjustment necessary to my account to correct the erroneous entry. A written notice explaining the changes will be sent to me by YVEA. I understand that YVEA may assess a fee of $20 if my financial instituion dishonors the electronic transaction.

Signature

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