Energy Credit Authorization Form
Energy Credit Authorization Form
Please complete this form to ensure a seamless access and review process.
Personal Information
Name
Address
Phone number
Utility Information
Company Name
Account Number
Address (if different)
Billing Cycle
-
Monthly
-
Bi-monthly
-
Quarterly
-
Annually
Authorization
I, the undersigned, give permission to the organization to obtain and review my energy consumption and billing records from the utility provider listed above. This information will be used to apply for relevant energy credits, rebates, or assistance programs on my behalf.
Name:
Date:
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