Sce 14 796 Form PDF Details

The Form 14-796 serves as a pivotal document for Southern California Edison customers, providing a structured way for individuals to authorize third parties to access their customer information or take action on their behalf. Issued on March 17, 2016, and becoming effective on April 16, 2016, this form outlines a legally binding agreement meant to safeguard both the customer's and the utility's interests. It meticulously details the types of actions and information a designated agent can request, including billing records, service agreements, and rate analyses, among others. Customers can customize the authorization's scope through initialing specific permissions and selecting the authorization's duration, which can range from a single instance to up to three years. Additionally, it stipulates the format in which the information should be provided to the agent, thereby ensuring clarity and preventing misunderstandings. Importantly, it includes provisions to protect the utility from liability, should the information released be misused, and offers customers the flexibility to rescind the authorization at any time. This form embodies a crucial tool for managing utility services, facilitating a broad array of transactions and inquiries that can enhance customer service experiences and operational efficiency.

QuestionAnswer
Form NameSce 14 796 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namescustomers behalf form, receive customer information template, form information behalf form, 14 796 download

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Southern California Edison

Revised

Cal. PUC Sheet No.

58949-E

Rosemead, California

(U 338-E)

Cancelling Revised

Cal. PUC Sheet No.

48656-E

Sheet 1

AUTHORIZATION TO: RECEIVE CUSTOMER

INFORMATION OR ACT ON A CUSTOMER’S BEHALF

Form 14-796

(To be inserted by utility)

Issued by

(To be inserted by Cal. PUC)

Advice

3381-E

R.O. Nichols

Date Filed

Mar 17, 2016

Decision

 

Senior Vice President

Effective

Apr 16, 2016

1C8

 

 

Resolution

 

 

AUTHORIZATION TO: RECEIVE CUSTOMER

INFORMATION OR ACT ON A CUSTOMER’S BEHALF

THIS IS A LEGALLY BINDING CONTRACT – READ IT CAREFULLY

I,

 

NAME

 

 

 

 

 

 

(T)

of

 

 

(Customer) have the following mailing address

 

NAME OF CUSTOMER RECORD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

, and do hereby appoint

 

MAILING ADDRESS

CITY

 

 

STATE

ZIP

 

 

 

 

 

 

of

 

 

 

 

 

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

1.

 

_________________

 

 

SERVICE ADDRESS

SERVICE ACCOUNT NUMBER

 

2.

 

_________________

 

 

SERVICE ADDRESS

SERVICE ACCOUNT NUMBER

 

3.

 

_________________

 

 

SERVICE ADDRESS

SERVICE ACCOUNT NUMBER

 

(For more than three accounts, please list additional Service Addresses and Service Account Numbers on a separate sheet and attach it to this

(T)

form)

 

 

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 (T)

(initial or put an ‘x’ inside all applicable boxes):

1. Request and receive billing records, billing history and all meter usage data used for bill calculation for all of my account(s), as specified herein, regarding utility services furnished by the Utility.1

2.EPA Benchmarking

3.Request and receive copies of correspondence in connection with my account(s) concerning (initial all that apply):

a.Verification of rate, date of rate change, and related information;

b.Contracts and Service Agreements;

c.Previous or proposed issuance of adjustments/credits; or

d.Other previously issued or unresolved/disputed billing adjustments.

4.Request investigation of my utility bill(s)

5.Request special metering, and the right to access interval usage and other metering data on my account(s).

6.Request rate analysis.

7.Request rate changes.

8.Request and receive verification of balances on my account(s) and discontinuance notices.

1The Utility will provide standard customer information without charge up to two times in a 12 month period per service account. After two requests in a year, I understand I may be responsible for charges that may be incurred to process this request.

Form 14-796

Page 1 of 2

3/2016

AUTHORIZATION TO: RECEIVE CUSTOMER INFORMATION OR ACT ON A CUSTOMER’S BEHALF

 

I (CUSTOMER) AUTHORIZE THE RELEASE OF MY ACCOUNT INFORMATION AND AUTHORIZE MY AGENT

 

TO ACT ON MY BEHALF ON THE FOLLOWING BASIS2 (initial one box only):

 

 

One time authorization only (limited to a one-time request for information and/or the acts and functions

 

 

Specified above at the time of receipt of this Authorization).

 

 

One year authorization - Requests for information and/or for the acts and functions specified above will be

 

 

accepted and processed each time requested within the twelve month period from the date of execution of

 

 

this Authorization.

 

 

Authorization is given for the period commencing with the date of execution until

 

 

___________________ (Limited in duration to three years from the date of execution.) Requests for

 

 

information and/or for the acts and functions specified above will be accepted and processed each time

 

 

requested within the authorization period specified herein

 

RELEASE OF ACCOUNT INFORMATION:

 

The Utility will provide the information requested above, to the extent available, via any one of the following.

 

My (Agent) preferred format is (check all that apply):

 

 

Hard copy via US Mail (if applicable): _______________________________________________________

 

 

 

 

Facsimile at this telephone number: __________________

 

 

 

 

Electronic format via electronic mail (if applicable) to this e-mail address:____________________________

 

 

 

I (Customer), __________________________________(print name of authorized signatory), declare under penalty

 

of perjury under the laws of the State of California that I am authorized to execute this document manually or

(T)

electronically on behalf of the Customer of Record listed at the top of this form and that I have authority to financially

(T)

bind the Customer of Record. I further certify that my Agent has authority to act on my behalf and request the release

 

of information for the accounts listed on this form and perform the specific acts and functions listed above. I

 

understand the Utility reserves the right to verify any authorization request submitted before releasing information or

 

taking any action on my behalf. I authorize the Utility to release the requested information on my account or facilities

 

to the above Agent who is acting on my behalf regarding the matters listed above. I hereby release, hold harmless,

 

and indemnify the Utility from any liability, claims, demands, causes of action, damages, or expenses resulting from:

 

1)any release of information to my Agent pursuant to this Authorization; 2) the unauthorized use of this information by my Agent; and 3) from any actions taken by my Agent pursuant to this Authorization, including rate changes. I understand that I may cancel this authorization at any time by submitting a written request. [This form must be signed by someone who has authority to financially bind the customer (for example, CFO of a company or City Manager of a municipality).]

AUTHORIZED CUSTOMER SIGNATURE TITLE (IF APPLICABLE)

 

 

TELEPHONE NUMBER

 

(T)

Executed this

 

day of

 

 

 

 

 

at

 

 

 

 

 

 

 

MONTH

 

 

YEAR

 

 

CITY AND STATE WHERE EXECUTED

 

I (Agent), hereby release, hold harmless, and indemnify the Utility from any liability, claims, demand, causes of

 

action, damages, or expenses resulting from the use of customer information obtained pursuant to this authorization

 

and from the taking of any action pursuant to this authorization, including rate changes. I also hereby indicate my

(T)

consent to execute and submit this signature electronically.

 

 

 

 

(T)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENT SIGNATURE

 

 

 

 

 

TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPANY

 

 

 

 

 

 

 

 

Executed this

 

day of

 

 

 

 

 

 

 

 

 

 

 

 

MONTH

 

 

YEAR

 

 

 

 

 

2If no time period is specified, authorization will be limited to a one-time authorization.

Form 14-796

Page 2 of 2

3/2016

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Part number 1 of completing form customer information act

2. Once your current task is complete, take the next step – fill out all of these fields - THIS IS A LEGALLY BINDING CONTRACT, CITY, CITY, ZIP, NAME, MAILING ADDRESS, STATE, and do hereby appoint, NAME OF CUSTOMER RECORD, Customer have the following, MAILING ADDRESS NAME OF THIRD PARTY, I of to act as my agent and, SERVICE ACCOUNT NUMBER, SERVICE ACCOUNT NUMBER, and SERVICE ADDRESS with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

The best ways to complete form customer information act stage 2

3. The following segment is relatively simple, I of to act as my agent and, Request and receive billing, accounts as specified herein, EPA Benchmarking Request and, a Verification of rate date of, Request investigation of my, The Utility will provide standard, and T T T - each one of these empty fields will have to be filled in here.

form customer information act writing process clarified (part 3)

In terms of Request investigation of my and I of to act as my agent and, ensure that you review things in this current part. Both of these could be the key ones in the page.

4. To move forward, the next form section involves typing in several form blanks. Examples of these are AUTHORIZATION TO RECEIVE CUSTOMER, One time authorization only, commencing with, the period, is given, for, RELEASE OF ACCOUNT INFORMATION The, Hard copy via US Mail if, I Customer print name of, and T T T T T, which you'll find integral to going forward with this PDF.

form customer information act writing process shown (step 4)

5. As you approach the end of your document, you'll find a couple extra points to do. Particularly, AUTHORIZED CUSTOMER SIGNATURE, I Customer print name of, TELEPHONE NUMBER, TELEPHONE NUMBER, AGENT SIGNATURE, CITY AND STATE WHERE EXECUTED, COMPANY, day of, MONTH, YEAR, YEAR, day of, MONTH, and T T T T T should all be filled out.

Writing segment 5 of form customer information act

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