Fillable THIRD PARTY NOTIFICATION REQUEST (Owatonna Public Utilities)

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THIRD PARTY NOTIFICATION REQUEST (Owatonna Public Utilities)

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THIRD PARTY NOTIFICATION REQUEST
If you want a third party authorized to discuss your account with OPU on your behalf, and/or to be
notified of a potential disconnection, please complete this form and return it to:
Owatonna Public Utilities
208 S. Walnut Ave.
P.O. Box 800
Owatonna, Minnesota 55060
OPU will make every effort to send a copy of the Disconnection Notice to the party specified. The
customer making this request understands OPU assumes no liability should the third party fail to
receive and/or act upon the notification.
Customer Information:
Name OPU Account Numbe
r
Service Address
A
pt/Unit #
Cit
y
, State, Zip
Primar
y
Phone Secondar
y
Phone
OPU has my permission to provide information to and accept information from the party named
in this a
g
reement:
Customer Si
g
nature Date
Third Party Information:
Name
Mailin
g
ddress
A
pt/Unit #
Cit
y
, State, Zip
Primar
y
Phone Secondar
y
Phone
** Third Part
y
Si
g
nature Date
** - This request cannot be accepted without the Third Party’s signature.
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THIRD PARTY NOTIFICATION REQUEST (Owatonna Public Utilities)

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Completed 8 June 2021

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