Capital Credit Inquiry Form

Capital Credit Inquiry

Please fill out as much information below as possible. Our team will review this information and respond with any questions as soon as possible. If your request is urgent, please contact our office at (618) 842-2196 during our normal business hours of Monday-Friday, 8am - 5pm.

Choose the option that best describes you:(Required)

I am or have been a Wayne-White Counties Electric Cooperative member. I am submitting this request on my own behalf.

I am submitting this request on behalf of a deceased member.

Member Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Wayne-White Electric Information

Member Account Number(Required)

Maiden/Previous Name(s)(Required)

Your relationship to member(Required)

If other, please describe(Required)

Additional Information

Year Starting(Required)

Year Ending

Additional Information/Previous Addresses

Please enter any additional information that may help us find your Capital Credits

Supporting Documentation

Max. file size: 100 MB.

Death certificates may help us determine capital credit eligibility.

Capital Credit Inquiry Form