SCE Usage Authorization

Step 1 of 2
AUTHORIZATION TO: RECEIVE CUSTOMER INFORMATION OR ACT ON A CUSTOMER’S BEHALF
Name
NAME OF CUSTOMER RECORD
MAILING ADDRESS
NAME OF THIRD PARTY
MAILING ADDRESS
City
State
ZIP
to act as my agent and consultant (Agent) for the listed account(s) and in the categories indicated below: ACCOUNTS INCLUDED IN THIS AUTHORIZATION
Service Address
SERVICE ACCOUNT NUMBER
SERVICE ADDRESS
SERVICE ACCOUNT NUMBER
SERVICE ADDRESS
SERVICE ACCOUNT NUMBER
SERVICE ADDRESS
SERVICE ACCOUNT NUMBER
SERVICE ADDRESS
SERVICE ACCOUNT NUMBER
SERVICE ADDRESS
SERVICE ACCOUNT NUMBER
SERVICE ADDRESS
SERVICE ACCOUNT NUMBER
INFORMATION, 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):