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Community Cares Participation Form
By submitting this form, you are joining the Community Cares program. This program authorizes Riverland Energy Cooperative to round up your bill each month to the next whole dollar, and donate the rounded-up amount to the Riverland Community Cares Foundation. If you have questions about the program, please call the co-op at 800-411-9115.
Community Cares Participation Form
First Name
Last Name
Email
Phone Number
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
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Federate States of Micronesia
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Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Nebraska
Nevada
New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
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Puerto Rico
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Account Number
Agreement
I understand that by enrolling in this program, I am giving Riverland Energy Cooperative permission to round my bill up each month to the nearest whole dollar and donate the rounded-up amount to the Riverland Community Cares Foundation. I also understand that the Foundation will administer these funds.
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