Please print out the form below and send to Black Hills Electric Cooperative, P.O. Box 792, Custer, S.D. 57730, or e-mail to bhec@bhec.coop.Thank you for your help.
Name of former member: _____________________________________
Spouse: __________________________________________________
If deceased, executor of estate: ________________________________________
Current address: ________________________________________________
Former address: _____________________________________________________
Current phone number: __________________________________________________
Person giving information: _____________________________________________
Relationship: _______________________________________________
Phone: _____________________________________________
