Hood River Electric & Internet Co-op (HR Co-op) members may request that their capital credit refunds be donated to our member assistance fund. Fill out the form to request that your credits be donated. Please note that your donation will apply to all of your HR Co-op accounts, for all future capital credit refunds until you contact us to request a change.Member Name(Required) First Last Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Account Number(Required) Email PhoneAuthorization(Required) I authorize and request that my capital credits for all of my HR Co-op accounts be donated to HR Co-op member assistance programs. I hereby verify the above information to be true and complete. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.CAPTCHAUntitled
