Capital Credits Claim Form 2026

Member Information

Name
Name
First Name
Last Name
Current Mailing Address
Current Mailing Address
City
State/Province
Zip/Postal
Country
Previous Physical Address
Previous Physical Address
City
State/Province
Zip/Postal
Country

Capital Credits Claim Disclaimer

Disclaimer Notice
By submitting this claim, you certify that the information provided is true, accurate, and complete to the best of your knowledge. Submission of this claim does not guarantee payment or establish ownership of any capital credits. All claims are subject to verification and approval in accordance with the Cooperative’s Bylaws, Board policies, and applicable laws. The Cooperative may request additional documentation to verify your identity or legal authority to claim the funds. If this claim is submitted on behalf of another individual, estate, or legal entity, you certify that you are authorized to act on its behalf. The Cooperative reserves the right to deny any claim that cannot be verified and to recover any funds issued based on false, misleading, or fraudulent information. By clicking “I Agree” and submitting this claim, you acknowledge that you have read and accepted these terms and that your electronic submission constitutes your electronic signature. privacy policies, etc.)
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