In-Care-Of Responsibility Form

I, the undersigned consumer of record, do hereby authorize the use of the following:

In-Care-Of Responsibility Form

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I acknowledge that because the bills are to be sent to an address other than my own, Holy Cross Energy, a Colorado corporation, cannot be held responsible for damage or inconvenience if this account is disconnected due to unpaid charges. Both parties listed will receive FINAL NOTICE of discontinuance of service for unpaid balances due. The consumer may request a change of the In-Care-Of by letter or completion of a new Responsibility form. If the In-Care-Of correspondence is returned to Holy Cross Energy because it was undeliverable, the name and address will be replaced by the consumer's main address. Upon request by the In-Care-Of party, the main address will be restored as the billing address. I agree to be responsible for all charges for electric service, and any penalties incurred if the account should become delinquent or disconnected. Electronic Signature of requestor: By typing in your name, you are agreeing to the terms of this Agreement.

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