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



Download 5.34 Kb.
Date28.05.2018
Size5.34 Kb.
Avalon Energy Services, LLC
Authorization to Release Natural Gas 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 natural gas usage, billing, payment data and rate class for the accounts listed below or attached.

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

__________________ ____________________________ __________________________

__________________ ____________________________ __________________________

__________________ ____________________________ __________________________



__________________ ____________________________ __________________________

Download 5.34 Kb.

Share with your friends:




The database is protected by copyright ©ininet.org 2020
send message

    Main page