This form must be submitted prior to your FIRST Payment Request. Submitted Payment Requests will NOT be processed without authorized matching signatures from this form. Following the instructions below to complete and submit this form. Instructions
Print the Signature Authorization and/or Change Request form.
Complete the information for ALL boxes on the form*. All blocks are to be completed in order to properly process your request.
Sign and date the form. The authorized signature must be the authorized signature for the loan and must be notarized.
Mail the ORIGINAL form to: Cherie Stiffler / Karen Dellinger PENNVEST Finance Department 22 S. Third Street Harrisburg, PA 17101
Changes to this form require a new form to be submitted with all new original signatures** sent to the same address.
*Engineer signature must include Professional Engineer Number (P.E.) if appropriate. **Original signatures should be on the Signature Authorization Form.
If there are any personnel changes, people retire or leave office, a new Signature Authorization Form must be completed with all new signatures including previous officials that may have already signed the document.