If so, please complete this form and click on the submit button at the bottom.
I am moving: (date)
Please send my final bill to:
Name
Address
City, State, Zip
Telephone
The new occupant of the property will be: (if not known, skip to next section)
New Name
New Telephone
Are they?
owner
renter
The owner of the property is:
Owner's Name
Owner's Address
Owner's City, ST, Zip
Owner's Telephone
YES
I will continue to take electric service from your cooperative.
NO
I will
NOT
be able to receive electric service from your cooperative.
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TIP RURAL ELECTRIC COOPERATIVE
PO Box 534
Brooklyn, IA 52211
Phone 641-522-9223
Fax 641-522-9271
EMAIL US
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ICE Technologies
Pella, Iowa
641-628-8724
Copyright ©2002
TIP Rural Electric Cooperative