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Consent For Tenant

Member Name:

Account Number: Land Location:

As the landowner of the above land location and the individual named on the associated utility account identified by the Account Number above (the “Utility Account”), I hereby authorize Battle River Power Coop Wires Division to disclose the following information to the tenant listed below (the “Tenant”) for purposes of administering the Utility Account:

• My name and contact information;

• Details respecting the Utility Account, including but not limited to amounts owing with respect to the Utility Account and services provided; and

• Utility bills relating to the Utility Account.

Renter Name: _________________________ Phone Number: ____________________

Address: _________________________ Fax Number: ____________________

_________________________ Postal Code: ____________________

This consent is effective as of , 20 until further notice.

I am aware and understand that:

1. Execution of this consent does not waive my responsibilities for the Utility Account as the Landowner and individual named on the Utility Account.

2. The Utility Account will remain in my name.

3. I will be notified if the Utility Account is subject to arrears, a notice of disconnect is delivered, or the utility services are disconnected.

4. By executing this consent, I am authorizing Battle River Power Coop Wires Division to send a copy of all future utility bills relating to the Utility Account to the Tenant at the address identified above.

5. I will continue to receive a copy of all future utility bills relating to the Utility Account unless the following is initialed:

I do not require a copy of all future utility bills relating to the Utility Account to be sent to me. By waiving my right to not have a copy of all future utility bills sent to me, I acknowledge this does not waive my responsibilities as landowner and the individual named on the Utility Account.

___________________________________ __________________________________

Member Signature Date:

Battle River Power Coop Wires Division is committed to meeting the requirements of all privacy legislation. It is a priority to safeguard any information provided by our members. At Battle River Power Coop, member information is maintained as strictly confidential. Unless you authorize us to release it, or release is required or permitted by law, we will not disclose information about you to third parties.

If you have any questions with respect to this disclosure of your personal information, please contact the Utility Billing Department at 1-877-428-3972.

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