Capital Credits - Bulloch Solutions

Capital Credit Search

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BULLOCH TELEPHONE COOPERATIVE CLAIM FORM

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Existing Member Name

First

Last

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Updated Name

First

Last

Phone

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please Provide one of the following:

Account Number

Member Number

Telephone Number

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I am a residential customer and have not deducted the cost of communication service on any tax return for the years prior to 1990.

The qualified Member above is deceased and I am claiming the Patronage refund on their behalf. I have included a death certificate and a court document to verify that I am qualified to receive the refund and will distribute the proceeds according to the laws of Georgia.

My entity is incorporated under the corporate laws of Georgia and our state issued control number below.

Control Number

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