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Submit A Member Name Change Form

The Member Name Change Form is provided for MEC members who choose to keep their existing service, but require a name change on their account due to marriage, divorce or another legal name change.

Please note that members will be prompted to upload supporting documents prior to submission.

Marriage – a copy of marriage certificate and driver’s license;
Divorce – a copy of divorce decree and driver’s license; or
Other Legal Name Change – legal supporting documents and driver’s license.

Questions? Please contact our Member Services department, weekdays from 8 a.m. to 5 p.m. at (406) 541-4433.

Member Name Change Form

The attached Name Change Form is provided for MEC members who choose to keep their existing service, but require a name change on their account due to marriage, divorce or another legal name change. Note: if there is an existing balance on the account, the balance will remain unchanged.

Date(Required)
Account Number(Required)
Service Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone(Required)
Current Name on Account(Required)
First Last
Change Name To(Required)
First Last
Birth Date(Required)
Last Four Digits of Social Security Number(Required)
I am the current account holder of the service address provided. I am submitting this form due to the reason selected below:(Required)
- Marriage
- Divorce
- Other Legal Name Change
Please note: You will be prompted to upload supporting documents prior to submission. Marriage - a copy of marriage certificate and driver's license. Divorce - a copy of divorce decree and driver's license. Other Legal Name Change - legal supporting documents and driver’s license.
Consent(Required)
I hereby certify that all of the information provided on this Name Change Form (and other supporting documentation) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for a review or discontinuation of service.
Consent
Consent(Required)
I understand that outstanding balances on the current account will remain the same, regardless of name change.
Consent
Required Supporting Documents(Required)
Please upload the following: Marriage - a copy of marriage certificate and driver's license. Divorce - a copy of divorce decree and driver's license. Other Legal Name Change - legal supporting documents and driver’s license.
Drop files here or

Max. file size: 20 MB.

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