Voter Designation Form
This form must be on file when membership is held by an entity, pursuant to the bylaws. With this form, the entity authorizes the designated person to vote on behalf of the entity member and/or serve on the board of directors.
Complete this form then submit the form by clicking the "Submit Form" button at bottom.
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Customer Number:
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Organization Name:
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Email Address:
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Name of Designated Person:
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Date:
(MM/DD/YYYY)
The undersigned entity, member of Medina Electric Cooperative, Inc., hereby designates the above listed "Designated Person" to act for the entity in accordance with the Bylaws of the Cooperative. This includes member voting matters and eligibility to serve as a director of the cooperative. Such designation shall remain in effect until it is revoked by the undersigned entity and notice is given in writing to the cooperative.
To authorize the designated person, please select the entity type that best applies and complete the information in the corresponding section below.
If the entity type is an LLC, Non-profit, or an Unincorporated Association, please select "Corporation".
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Entity Type:
Partnership
Corporation
Sole Proprietorship Or Single-member LLC
Multi-member LLC
Trust
Government
Partnership
Name of Partnership:
Partner's Name:
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Partner's Signature
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Partner's Name:
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Partner's Signature
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Partner's Name:
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Partner's Signature
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Corporation, LLC, Non-profit, or Unincorporated Association
Name of Organization:
Federal Tax ID #:
Officer's Name:
Officer's Title:
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Officer's Signature
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Sole Proprietorship or Single-member LLC
Owner's Name:
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Owner's Signature
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Multi-member LLC
Name of Organization:
Federal Tax ID #:
Member Name:
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Member Signature
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Member Name:
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Member Signature
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Member Name:
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Member Signature
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Trust
Trustee Name:
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Trustee Signature
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Trustee Name:
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Trustee Signature
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Government
Officer's Name:
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Government Signature
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