Member Update/Change Form

FOR MEMBERS OF CONSUMERS ENERGY COOPERATIVE OF IOWA ONLY!!

Please feel free to contact us with any questions regarding this information.

Contact Information:
Consumers Energy
2074 242nd Street
Marshalltown, IA 50158
Phone: 641-752-1593 or 800-696-6552
Fax: 641-752-5738

Member Information

Name(s) on Account

Account Number(s)

This number will not be longer than 7 digits.

Address

City/Town

State/Province

ZIP/Postal Code

_{Select One of the Following Options:}

_{Check the appropriate box(es) below for the type of change(s) requested to the account(s) referenced.}

Add a New Joint Member to Individual Account

New Joint Member

New Joint Member's Name

Address

City/Town

State/Province

ZIP/Postal Code

Driver's License Number - New Joint Member

Date of Birth - New Joint Member

Phone - New Joint Member

Employer

Email Address - New Joint Member

Signature of New Joint Member

Sign above

Date Signed by New Joint Member

Name Change of Member (Attach Copy of Marriage Certificate or Divorce Decree)

Member Name Change

Marriage Certificate or Divorce Decree

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

New Name

Driver's License Number - New Name

Date of Birth - New Name

Phone - New Name

Signature using New Name

Sign above

Date Signed by Member using New Name

Remove an Existing Member from an Account

Remove Listed Member

Reason for Change

Death Certificate or Divorce Decree

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.

Name to Remain on Individual Account

Driver's License Number - Individual Account Holder

Phone - Individual Account Holder

Date of Birth - Individual Account Holder

Signature of Individual Account Holder

Sign above

Date Signed by Individual Account Holder

Authorization to Discuss Account with Someone Other than Member(s)

Add Verified Person to Account

Name - Other than Member(s)

Driver's License Number - Other than Member(s)

Date of Birth - Other than Member(s)

Phone - Other than Member(s)

Signature of Member

Sign above

Date Signed by Member

Add SS# and Driver's License Number to Existing Account

Driver's License Records

Driver's License Number - Existing Account

Privacy & Signature

Privacy Compliance - FOR PRIVACY COMPLIANCE, I (WE) AUTHORIZE CONSUMERS ENERGY TO CHANGE THE ELECTRIC ACCOUNT(S) NOTED ABOVE TO REFLECT THE CHANGES MARKED ABOVE. CHANGE REQUESTS BECOME EFFECTIVE WHEN THIS FORM IS SUBMITTED TO CONSUMERS ENERGY.

Member Signature

Sign above

Date Signed by Member

Joint Member Signature

Sign above

Date Signed by Joint Member

Signature Disclosure - For the purpose of Consumers Energy online forms, when the word(s) "signature" "member signature" "joint member signature" or "signature of responsible party" appears, a typed, legal name is an acceptable substitute. As long as the complete, legal name appears in each blank for which a signature was requested, the form is accurate and binding (pending accurate completion of all other form sections). It is not necessary to print and sign the form if users plan on submitting the form electronically. I agree that my electronic signature on this agreement/document has the same effect as a signature signed in ink.

FOR MEMBERS OF CONSUMERS ENERGY COOPERATIVE OF IOWA ONLY!!

Select One of the Following Options:Check the appropriate box(es) below for the type of change(s) requested to the account(s) referenced.

_{Select One of the Following Options:}

_{Check the appropriate box(es) below for the type of change(s) requested to the account(s) referenced.}