American Electric Power –
Central Power and Light Company
CUSTOMER AUTHORIZATION FOR THE RELEASE OF PROPRIETARY INFORMATION
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Customer
Name: |
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Customer
Address: |
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City
and State: |
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Zip: |
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Customer Telephone Number: |
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Account Number(s) or
ESI ID(s):
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I, as the authorized
representative for the above named customer, authorize the release of the
following information:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Request Interval
Data (Check if Yes) ____
Interval Data File Format (Select one) Excel _____
Lotus 123 _____ Comma
Delimited Text ____
I hereby request
that the information be released to:
Name:
____________________________________________________________________
Company:
_________________________________________________________________
Address:
__________________________________________________________________
Phone Number:
______________________ Fax Number:
______________________
Email Address:________________________________(required only if interval data
requested)
Authorized By:
____________________________________________________________
Printed Name:
_____________________________________________________________
Social Security #-Required only if residential account:
__________________________________________________________________________
Title:
_____________________________________________________________________
Date:
_____________________________________________________________________
Return
Completed Form To:
817-498-9820 or 978-246-6148
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