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United States Department of Agriculture
Rural Utilities Service
BORROWER DESIGNATION
TAX IDENTIFICATION NUMBER
REQUEST FOR MAIL LIST DATA
LEGAL NAME
PRIMARY E-MAIL ADDRESS
CORRESPONDENCE ADDRESS
STREET 1
WEBSITE URL
2
3
CITY
REGULAR BOARD MEETING HELD ON
STATE
ZIP
PHYSICAL ADDRESS
STREET 1
DATE SET FOR NEXT ANNUAL MEETING (mm-dd-yy)
2
3
CITY
PHONE NO.
STATE
FAX NO.
ZIP
CORPORATE OFFICIALS
MAILING ADDRESS
(include P.O. Box, Street Address or
Rural Route, City, State, and Zip Code)
NAME
(Salutation, First, Middle, and Last)
MANAGER OR CEO
TITLE
PRESIDENT
TITLE
STREET 1
2
3
CITY
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STREET 1
2
3
CITY
VICE PRESIDENT
STATE
STREET 1
2
3
TITLE
SECRETARY
TITLE
TREASURER
TITLE
CITY
STREET 1
2
3
CITY
STREET 1
2
3
CITY
STREET 1
TITLE
2
3
CITY
STREET 1
TITLE
2
3
CITY
STREET 1
TITLE
2
3
CITY
STREET 1
TITLE
2
3
CITY
STREET 1
TITLE
2
3
CITY
RUS Form 87 (Rev. 5-2005)
CORPORATE OFFICIALS (Continue)
MAILING ADDRESS
(include P.O. Box, Street Address or
Rural Route, City, State, and Zip Code)
NAME
(Salutation, First, Middle, and Last)
STREET 1
2
3
TITLE
CITY
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STATE
ZIP
STREET 1
2
3
TITLE
CITY
STREET 1
2
3
TITLE
CITY
STREET 1
2
3
TITLE
CITY
RELATED ORGANIZATIONS
MAILING ADDRESS
(include P.O. Box, Street Address or
Rural Route, City, State, and Zip Code)
NAME OF ORGANIZATION
ATTORNEY
STREET 1
2
3
CITY
PHONE
C.P.A.
STREET 1
2
3
CITY
PHONE
CONSULTING ENGINEER
STREET 1
2
3
CITY
PHONE
DATE PREPARED (mm-dd-yy)
RUS Form 87 ( Rev. 5-2005 )
SIGNATURE
TITLE
File Type | application/pdf |
File Modified | 2014-05-22 |
File Created | 2005-05-11 |