You may also download the Business Certification of Entitlement Form (PDF). Name(Required) First Last Business Account Name(Required) I hereby make claims to the capital credits allocated by Golden Valley Electric Association, Inc. to the account listed above for the following years:(Required) Upload legal documentation to support and validate claim for ownership of capital credits(Required)Max. file size: 300 MB.Consent(Required)I hereby certify and declare that: I am the party legally entitled to claim ownership of these capital credits; I have attached legal documentation to support and validate my claim for ownership of these capital credits above; I will be responsible for distributing the capital credits claimed in accordance with any predetermined agreements of the business to which they were allocated; I accept responsibility regarding any litigation which may arise from subsequent claims to these capital credits; and I understand that a copy of this certification statement will be released to any party making subsequent claim to these capital credits. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Claimant Electronic Signature (Full Name)(Required) Mailing Address of Claimant(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code CAPTCHANameThis field is for validation purposes and should be left unchanged.
