If you are the rightful heir for the capital credit recipient listed on the form below, please do the following:

  • Read the form carefully.
  • Complete the information required.
  • Upload a copy of your driver's license or legal ID.
  • Upload a copy of the deceased member's death certificate or obituary.
  • Sign the form.
  • Have a person who is not a relative also sign the form, witnessing your signature.

Once you sign the form, it is your responsibility to see, if necessary, that any other heirs or parties receive their portion of the check.

We must receive your form and approve it before the capital credit check will be mailed to you. Please note that any outstanding bad debts owed by the member to the Cooperative will be deducted from the check.

If you need assistance, please contact us at 1-800-239-3092.

 

Upload a photo of the death certificate or obituary.
One file only.
100 MB limit.
Allowed types: gif, jpg, png, svg.
Upload a photo of your driver's license or ID.
One file only.
100 MB limit.
Allowed types: gif, jpg, png, svg.
I, the undersigned, hereby apply to receive the capital credit for the above account. In applying to receive the capital credit on this account, I certify that I am the person legally entitled to receive the same and in consideration of payment of the credit to me, I agree that I will indemnify and hold harmless Pioneer Electric Cooperative, Inc., from all loss or damage, including incidental and consequential damages, which it may incur or become in any way obligated to pay, arising directly or indirectly out of its payment to me of the capital credit.
Sign above