Avalon Energy Services, llc authorization to Release Electric Billing and Payment Data



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Avalon Energy Services, LLC
Authorization to Release Electric Billing and Payment Data
The undersigned Customer hereby authorizes Avalon Energy Services, LLC (Avalon) and its third-party suppliers to receive Customer’s most recent twenty-four (24) months of electricity usage, demand, billing, payment, interval data and rate class for the accounts listed below or attached. This information may also include, but is not limited to, service configuration, transformer data, and disconnect history.

Customer ___________________________________________________


Customer’s Title ___________________________________________________
Company (legal name) ___________________________________________________
Address ___________________________________________________
City, State, Zip ___________________________________________________
Telephone and Extension ___________________________________________________
Fax ___________________________________________________
email address ___________________________________________________
Customer’s Signature, Date ________________________________ _______________


Account Number Service Address Utility Identification Number

__________________ ____________________________ __________________________

__________________ ____________________________ __________________________

__________________ ____________________________ __________________________



__________________ ____________________________ __________________________


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