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.
Authorized Signators must register for a username and password and be linked as a Contact in Funds Disbursement. To register for a username and password go to www.pennvest.state.pa.us and select the My Account Login on the right. Follow the directions on the page. Once you have completed the registration contact either the Project Specialist for the project, the person currently in the Borrower Role, or Karen Dellinger firstname.lastname@example.org or Cherie Stiffler email@example.com to be added to the Contacts Tab in Funds Disbursement.
*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.