Operation Round Up Participation Form

Give a little, Help a lot!
 
An * indicates a required field.
 
First Name *
 
Last Name *
 
Home Phone *
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Current Address *
 
City *
 
State *
 
 
Zip Code *
 
E-mail address *
 
Re-enter E-mail address for verification *
 
Account Number *
 
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I understand that my contributions to Operation Round-Up are tax deductible and I will receive a summary of my contributions with my December and January statement and I may withdraw from this program by simply notifying Ouachita Electric Cooperative.