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Letter of Authorization

Date: ____________________

Customer Name: _______________________________________________________________

Customer Address: ______________________________________________________________

City/State/Zip: _________________________________________________________________

Customer Telephone number: _____________________________________________________

Current Electric Provider: ________________________________________________________

 I ____________________________, as the authorized representative for the above named customer, authorized the release of the following billing information for the following accounts this request should include billing record with surcharges and taxed for the most recent 12 months; energy usage data, to include kWh, kva, interval data, load factor and power factor as applicable to this account. 

ESI ID

ACCOUNT NUMBER

ADDRESS

TDSP

1

 

 

 

 

2

 

 

 

 

3

 

 

 

 

4

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 I hereby request that the information be released to:

Name:      Madeline Burleson                               Company: Texas CommercialEnergy   

Address: 1022 S. Greenville Avenue     Allen, TX   75002___

 Phone Number: 214-547-2550                            Fax Number: 214-853-4874    

 Email Address: madeline.burleson@mytce.com 

 Signature Block

 

Authorized Name: ___________________________________________    

Date: _____________ 

Tax ID Number: ____________________________________________

 Authorized Signature: ________________________________________

 Title: _____________________________________________________

                                                           


FAX THIS FORM TO 817-498-9820 OR 978-246-6148
 

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