Capital Credit Information Request

CAPITAL CREDIT INFORMATION REQUEST

Please complete the form below to the best of your ability. A Shelby Energy Cooperative representative will respond as soon as possible. If you have immediate needs, please call 800-292-6585 or e-mail us.

Current Capital Credit Information Request
Complete

Please enter your contact information here.

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Choose one:

Deceased Member's Full Name

Last 4 of SSN (deceased)

Date of Death

What can we help you with?

Please answer the questions below. If you are unsure, please mark "N/A".

Questions	Yes	No	N/A
Are you the sole heir to the estate?	Yes	No	N/A
Are you working with an attorney?	Yes	No	N/A
Has the deceased member's electric account been closed and paid?	Yes	No	N/A

Please provide the names of any co-heirs/co-executors.

Please provide the Name and Contact Information for your attorney.

If you have any of the following documents, please upload them or e-mail a copy

Upload Death Certificate

One file only.
20 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg.

Upload Appointing Orders (Court Documents)

* A member's will cannot be used as proof of appointment. Only an Order of Appointment or Order to Dispense can be accepted.
One file only.
20 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg.

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