Unclaimed Capital Credits

About Us: Capital Credits

You may complete this form for yourself or on behalf of another person. We require you to provide contact information as we must verify your identity before we can make any payment distributions.

I am contacting you with regard to my account

First Name on account:
Middle initial on account:
Last name on account:
List spouse or roommate names:
List all known former addresses:
Current Address:
Current phone number with area code (555-555-5555):

I am contacting you on behalf of another member

Is the member deceased? YesNo If yes to above, please list surviving spouse or Legal Representative's name and current addresses:
Has the member's name changed? If so please list the previous name:
List the member's current name:
Your name:
Your address (in case we need to contact you):
Your phone number with area code (555-555-5555):
Your e-mail address:

Dakota Electric Association

About Us: Capital Credits

I am contacting you with regard to my account

I am contacting you on behalf of another member