Notarized Guarantor Form printable pdf download

PO Box 1130

146 Faculty Street Ext.

Boone, NC 28607

Office (828) 264-3671, Fax (828) 262-6726

NOTARIZED GUARANTOR FORM

According to Rule R12-2 of the North Carolina Public Utility Law Rules and Regulations, this

Guarantor Form is accepted in lieu of/and in the amount equal to the required cash deposit for

electric service at the location below. The applicant agrees that information regarding his/her

account may be disclosed to his/her Guarantor as long as this agreement is in effect.

The Guarantor agrees to pay upon demand, within 10 days, any unpaid charges left owing on the

Applicant’s Inactive Account limited to the notarized amount below. Failure to pay upon demand

will result in the unpaid balance being transferred to the Guarantor’s Active Account, and the

Guarantor’s service may be disconnected if the bill remains unpaid. The Guarantor understands

that his/her credit rating will be disclosed to the Applicant by approval or disapproval of this

Guarantor Form.

I, the Guarantor, accept the conditions of this agreement as listed above by signing before a

Notary this ____________day of ____________________, 20___.

_________________________________

__________________________________________

Signature of Guarantor

Signature of Applicant

_________________________________

__________________________________________

Print Name - Guarantor

Print Name - Applicant

_________________________

__________________________________________

Account # - Applicant (Office Use Only/ Leave Blank)

Account # - Guarantor

For Service Location at: __________________________________________________________

Guaranteed Deposit (Amount from Application for Electric Service) $______________________

**All Required Fields Must Be Completed Prior to Notarization**

Notary Public: ________________________________

Commission Expires: ___________________________

Phone Number: _______________________________

Date: _______________________________________

Accepted for New River Light & Power Company By: ____________________________________

Notarized Guarantor Form