SCE Usage Authorization Please enable JavaScript in your browser to complete this form. - Step 1 of 2AUTHORIZATION TO: RECEIVE CUSTOMER INFORMATION OR ACT ON A CUSTOMER’S BEHALFi,Nameof,NAME OF CUSTOMER RECORD(Customer) have the following mailing addressMAILING ADDRESS CityStateZip, and do hereby appointNAME OF THIRD PARTYofMAILING ADDRESS CityCitySingle Line TextStateSingle Line TextZIPto act as my agent and consultant (Agent) for the listed account(s) and in the categories indicated below: ACCOUNTS INCLUDED IN THIS AUTHORIZATION1.Service AddressSingle Line TextSERVICE ACCOUNT NUMBER 2.SERVICE ADDRESSSingle Line TextSERVICE ACCOUNT NUMBER3.SERVICE ADDRESSSingle Line TextSERVICE ACCOUNT NUMBER4.SERVICE ADDRESSSingle Line TextSERVICE ACCOUNT NUMBER 5.SERVICE ADDRESS Single Line TextSERVICE ACCOUNT NUMBER 6.SERVICE ADDRESSSingle Line TextSERVICE ACCOUNT NUMBER7.SERVICE ADDRESSSingle Line TextSERVICE ACCOUNT NUMBERINFORMATION, ACTS AND FUNCTIONS AUTHORIZED – This authorization provides authority to the Agent. The Agent must thereafter provide specific written instructions/requests (e-mail is acceptable) about the particular account(s) before any information is released or action is taken. In certain instances, the requested act or function may result in cost to you, the customer. Requests for information may be limited to the most recent 12 month period.I (Customer) authorize my Agent to act on my behalf to perform the following specific acts and functions (initial or put an ‘x’ inside all applicable boxes): Checkboxes1.Request and receive billing records, billing history and all meter usage data used for bill calculation for all of my account(s), as specified herein, regarding utility services furnished by the Utility.Checkboxes2. EPA BenchmarkingCheckboxes3. Request and receive copies of correspondence in connection with my account(s) concerning (initial all that apply):Checkboxesa. Verification of rate, date of rate change, and related information;b. Contracts and Service Agreements;c. Previous or proposed issuance of adjustments/credits; ord. Other previously issued or unresolved/disputed billing adjustmentsCheckboxes4. Request investigation of my utility bill(s)5. Request special metering, and the right to access interval usage and other metering data on my account(s).6. Request rate analysis.7. Request rate changes.8. Request and receive verification of balances on my account(s) and discontinuance notices.NextI (CUSTOMER) AUTHORIZE THE RELEASE OF MY ACCOUNT INFORMATION AND AUTHORIZE MY AGENT TO ACT ON MY BEHALF ON THE FOLLOWING BASIS2 (initial one box only): CheckboxesOne time authorization only (limited to a one-time request for information and/or the acts and functions Specified above at the time of receipt of this Authorization). CheckboxesOne year authorization - Requests for information and/or for the acts and functions specified above will be accepted and processed each time requested within the twelve month period from the date of execution of this Authorization.CheckboxesAuthorization is given for the period commencing with the date of execution until Single Line Text(Limited in duration to three years from the date of execution.) Requests for information and/or for the acts and functions specified above will be accepted and processed each time requested within the authorization period specified herein RELEASE OF ACCOUNT INFORMATION:The Utility will provide the information requested above, to the extent available, via any one of the following. My (Agent) preferred format is (check all that apply):CheckboxesHard copy via US Mail (if applicable):Single Line TextCheckboxesFacsimile at this telephone number:Single Line TextElectronic format via electronic mail (if applicable) to this e-mail address:I (Customer),(print name of authorized signatory), declare under penalty of perjury under the laws of the State of California that I am authorized to execute this document manually or electronically on behalf of the Customer of Record listed at the top of this form and that I have authority to financially bind the Customer of Record. I further certify that my Agent has authority to act on my behalf and request the release of information for the accounts listed on this form and perform the specific acts and functions listed above. I understand the Utility reserves the right to verify any authorization request submitted before releasing information or taking any action on my behalf. I authorize the Utility to release the requested information on my account or facilities to the above Agent who is acting on my behalf regarding the matters listed above. I hereby release, hold harmless, and indemnify the Utility from any liability, claims, demands, causes of action, damages, or expenses resulting from: 1) any release of information to my Agent pursuant to this Authorization; 2) the unauthorized use of this information by my Agent; and 3) from any actions taken by my Agent pursuant to this Authorization, including rate changes. I understand that I may cancel this authorization at any time by submitting a written request. [This form must be signed by someone who has authority to financially bind the customer (for example, CFO of a company or City Manager of a municipality).]AUTHORIZED CUSTOMER SIGNATURE TITLE (IF APPLICABLE)Clear SignatureTELEPHONE NUMBER Executed thisDay ofSingle Line TextMonthSingle Line TextYearatCITY AND STATE WHERE EXECUTED I (Agent), hereby release, hold harmless, and indemnify the Utility from any liability, claims, demand, causes of action, damages, or expenses resulting from the use of customer information obtained pursuant to this authorization and from the taking of any action pursuant to this authorization, including rate changes. I also hereby indicate my consent to execute and submit this signature electronically. AGENT SIGNATUREClear SignatureTELEPHONE NUMBERCOMPANYExecuted thisDay ofSingle Line TextMonthSingle Line TextYearIf no time period is specified, authorization will be limited to a one-time authorization.Submit
