Free Utility Bill PDF Form

Free Utility Bill PDF Form

The Utility Bill form serves as a crucial document for individuals and businesses to request or provide information regarding utility services. This form typically includes details about the account holder, service address, and the type of utility services being requested. Understanding its purpose and proper completion is essential for effective communication with utility providers.

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The Utility Bill form serves as a crucial document for individuals and households managing their utility expenses. This form typically includes essential information such as the name and address of the account holder, the utility provider's details, and the billing period. It often outlines the types of services rendered, including electricity, water, gas, and other utilities, alongside their respective charges. Additionally, the form may display payment options, due dates, and any applicable late fees, ensuring that consumers are well-informed about their financial obligations. Understanding the components of the Utility Bill form can empower individuals to manage their utility costs effectively, fostering better budgeting and financial planning. Moreover, familiarity with this form can help consumers identify discrepancies or errors in billing, enabling them to address issues promptly with their service providers.

Utility Bill Sample

ENERGY STATEMENT

Account No:

1234567890-1

Statement Date:

09/07/2019

www.pge.com/MyEnergy

Due Date:

09/28/2019

 

 

Service For:

SPARKY JOULE 12345 ENERG'( CT

Questions about your bill?

Monday-Friday 7 a.m.-9 p.m. Saturday 8 a.m.-6 p.m. Phone: 1-800-743-5000 www.pge.com/MyEnergy

Ways To Pay

www.pge.com/waystopay

Your Account Summary

Amount Due on Previous Statement

$91.57

Payment(s) Received Since Last Statement

-91.57

Previous Unpaid Balance

$0.00

Current PG&E Electric Delivery Charges

$55.66

Silicon Valley Clean Energy Electric Generation Charges

$32.48

I Total Amount Due by 08/28/2019

$88.14

Monthly Billing History

 

 

 

 

Daily Usage Comparison

$200

 

 

 

 

 

 

 

1 Year

Last

Current

 

 

 

 

 

 

 

Ago

Period

Period

$150

 

 

 

 

 

 

 

12.50

12.16

12.67

$100

 

 

 

 

 

 

 

■ ■ ■

$50

 

 

 

 

 

 

 

Electric kWh / Day

 

 

 

 

 

 

 

 

 

 

$0

-+-----'-r-"-------

"'r�---

'-r"-----'-r-"

-----'-r�---

'-r"-----'-r"----'-r�---

'--r"------'-r"------i

0.12

0.16

0.17

2018 8/07

9/06 10/04 11/06 12/06 1/08 2/06

3/07 4/08

5/09 6/06

7/10 8/07 2019-�c____<=----

=::,__---l

 

 

 

Electric

D

Gas

 

Gas Therms/ Day

Visit www.pge.com/MyEnergy for a detailed bill comparison

Important Messages

The Family Electric Rate Assistance (FERA) Program provides a monthly discount on electric bills for income-qualified households of three or more persons. To see if you qualify, please call 1-800-PGE-5000 or apply online at www.pge.com/fera.

El Programa FERA ofrece ahorros mensuales solo en las facturas de electricidad a hogares de ingresos econ6micos bajos y medianos con tres o mas personas. Para determinar si califica, por favor llame al 1-800-PGE-5000 o puede aplicar a traves de nuestra pagina web www.pge.com/fera.

Continued on page 6

Please return this portion with your payment. No staples or paper clips. Do not fold. Thank you.

®

Account Number:

Due Date:

Total Amount Due:

Amount Enclosed:

123456789-1

09/28/2019

$88.14

$

PG&E

BOX 997300

SACRAMENTO, CA 95899-7300

Page 1 of 6

ENERGY STATEMENT

Account No:

1234567890-1

Statement Date:

09/07/2019

www.pge.com/MyEnergy

Due Date:

09/28/2019

 

 

Important Phone Numbers - Monday-Friday 7 a.m.-9 p.m., Saturday 8 a.m.-6 p.m. Customer Service (All Languages; Relay Calls Accepted) 1-800-743-5000

TTY 7-1-1

Servicio al Cliente en Espanol (Spanish) -��.P�IHf (Chinese)

1-800-660-6789

Djch VI) khach tieng Vi�t (Vietnamese)

1-800-298-8438

1-800-893-9555

Business Customer Service

1-800-468-4743

Rules and rates

You may be eligible for a lower rate. To learn more about optional rates or view a complete list of rules and rates, visit www.pge.com or call 1-800-743-5000.

If you believe there is an error on your bill, please call 1-800-743-5000 to speak with a representative. If you are not satisfied with our response, contact the California Public Utilities Commission (CPUC), Consumer Affairs Branch (CAB), 505 Van Ness Avenue, Room 2003, San Francisco, CA 94102, 1-800-649-7570 or 7-1-1 (8:30 AM to 4:30 PM, Monday through Friday) or by visiting www.cpuc.ca.gov/complaints/.

To avoid having service turned off while you wait for the outcome of a complaint to the CPUC specifically regarding the accuracy of your bill, please contact CAB for assistance. If your case meets the eligibility criteria, CAB will provide you with instructions on how to mail a check or money order to be impounded pending resolution of your case. You must continue to pay your current charges while your complaint is under review to keep your service turned on.

If you are not able to pay your bill, call PG&E to discuss how we can help. You may qualify for reduced rates under PG&E's CARE program or other special programs and agencies may be available to assist you. You may qualify for PG&E's Energy Savings Assistance Program which is an energy efficiency program for income-qualified residential customers.

Important definitions

Rotating outage blocks are subject to change without advance notice due to operational conditions.

Tier 1/Baseline allowance: Some residential rates are given a Tier 1/Baseline allowance - a CPUC approved percentage of average customer usage during summer and winter months. Your Tier 1/Baseline allowance provides for basic needs at an affordable price and encourages conservation. Your allowance is assigned based on the climate where you live, the season and your heat source. As you use more energy, you pay more for usage. Any usage over your baseline allowance will be charged at a higher price.

High Usage: An increased price per kWh whenever electricity usage exceeds four times the Baseline Allowance (Tier 1) in a billing period. This charge does not apply to Time-of-Use rate plans.

DWR bond charge: Recovers the cost of bonds issued by the Department of Water Resources (DWR) to purchase power to serve electric customers during the California energy crisis. DWR bond charges are collected on behalf of DWR and do not belong to PG&E.

Power Charge Indifference Adjustment (PCIA): Ensures that non-exempt customers under PG&E's GT and ECR rate schedules or who purchase electricity (generation) from non-PG&E suppliers pay their share of generation costs.

Gas Public Purpose Program (PPP) Surcharge. Used to fund state-mandated gas assistance programs for low-income customers, energy efficiency programs, and public-interest research and development.

Visit www.pge.com/billexplanation for more definitions. To view most recent bill inserts including legal or mandated notices, visit www.pge.com/billinserts.

Your Electric Charges Breakdown

Conservation Incentive

-$9.50

Transmission

12.42

Distribution

35.08

Electric Public Purpose Programs

4.71

Nuclear Decommissioning

0.33

DWR Bond Charge

1.91

Competition Transition Charges (CTC)

0.42

Energy Cost Recovery Amount

-0.22

PCIA

10.26

Taxes and Other

0.25

Total Electric Charges

$55.66

"PG&E" refers to Pacific Gas and Electric Company, a subsidiary of PG&E Corporation. © 2019 Pacific Gas and Electric Company. All rights reserved. Please do not mark in box. For system use only.

Update My Information (English Only)

Please allow 1-2 billing cycles for changes to take effect

Account Number: 1234567890-1

Change my mailing address to: ________________

City _____________ State

ZIP code ____

Primary

Primary

 

Phone#--------- Email --------------

Ways To Pay

Online via web or mobile at www.pge.com/waystopay

By mail: Send your payment along with this payment stub in the envelope provided.

By debit card, Visa, MasterCard, American Express, or Discover: Call

877-704-8470 at any time. (Our independent service provider charges a fee per transaction.)

At a PG&E payment center or local office: To find a payment center or local office near you, please visit www.pge.com or call 800-743-5000. Please bring a copy of your bill with you.

Page 2 of 6

ENERGY STATEMENT

Details of PG&E Electric Delivery Charges

Service For: 12345 ENERGY CT

Service Agreement ID: 111111111

Rate Schedule: E1 X Residential Service

07/02/2019 - 07/31/2019 Your Tier Usagel�-1��-2

Tier 1 Allowance

297.00

kWh

(30 days x 9.9 kWh/day)

Tier 1 Usage

297.000000

kWh

@$0.22376

$66.46

Tier 2 Usage

83.000000

kWh

@$0.28159

23.37

Generation Credit

 

 

 

-44.68

Power Charge Indifference Adjustment

 

 

10.26

Franchise Fee Surcharge

 

 

 

0.25

Total PG&E Electric Delivery Charges

$55.66

Electric Usage This Period: 380.000000 kWh, 30 billing days

30kWh

 

 

 

 

----- =

Average Daily Usage 12.67 I

24

 

 

 

 

 

 

 

 

 

 

18

 

 

 

 

 

 

 

 

 

 

12

---------

------------�•--·--- - ------

----

--

- -

6

 

 

 

 

 

 

 

 

 

 

0

--+------"P.__.,.___.,._.,.__.,.___.,._.,.__.,.___.,._.,.__.,.__.,._.,.__.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.____.,.___,

 

7/2

7/5

7/8

7/11

7/14

7/17

7/20

7/23

7/26

7/29

Due Date:

09/28/2019

Service Information

1111111111

Meter#

Current Meter Reading

37,710

Prior Meter Reading

37,330

Total Usage

380.000000 kWh

Baseline Territory

X

Heat Source

B - Not Electric

Serial

G

Rotating Outage Block

50

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 3 of 6

 

ENERGY STATEMENT

www.pge.com/MyEnergy

Details of Silicon Valley Clean Energy Electric Generation Charges

08/02/2019 - 08/31/2019 (30 billing days)

Service For: 12345 ENERGY CT

Service Agreement ID: 11111111

07/02/2019 - 07/31/2019

Rate Schedule:

E-1

$32.37

Generation - Total

380.000000 kWh @$0.08519

 

Net Charges 32.37

0. 11

Energy Commission Surcharge

Customers receive clean electricity and save money with SVCE. Please see updated

SVCE electric rates and comparisons to PG&E at www.svcleanenergy.com/rates

Total Silicon Valley Clean Energy

$32.48

Electric Generation Charges

Account No:

1234567890-1

Statement Date:

09/07/2019

Due Date:

09/28/2019

Service Information

 

Total Usage

380.000000 kWh

For questions regarding charges on this page, please contact:

SILICON VALLEY CLEAN ENERGY 1-844-474-7823 customerservice@SVCleanEnergy.org

Additional Messages

About Silicon Valley Clean Energy (SVCE) Serving 13 Santa Clara County communities, SVCE is a locally-controlled, public agency providing residents and businesses with electricity from renewable and hydroelectric sources.

Understanding SVCE Charges

PG&E continues to provide and bill for electric delivery. SVCE replaces PG&E generation charges. Under PG&E Electric Delivery Charges, note the Generation Credit. This is what PG&E would have charged for power, and now credits back to you. The Power Charge Indifference Adjustment and Franchise Fee are factored into SVCE rates. Learn more:

https://www.svcleanenergy.orgies/your-bi11/.

SVCE is committed to protecting customer privacy.

Learn about our privacy policy at www.svcleanenergy.org/customer-confidenti ality

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 4 of 6

 

ENERGY STATEMENT

www.pge.com/MyEnergy

Details of Gas Charges

08/02/2019 - 08/31/2019 (30 billing days)

Service For: 12345 ENERGY CT

Service Agreement ID: 1111111111

Rate Schedule: G1 X Residential Service

07/02/2019 - 07/31/2019

Your Tier Usagel�-1��-2

 

 

 

 

 

Tier 1 Allowance

17.70 Therms (30 days x

0.59 Therms/day)

 

 

Tier 1 Usage

5.000000Therms @$ 1.28395

$6.42

Gas PPP Surcharge ($0.09047 /Therm)

0.45

Total Gas Charges

 

 

$6.87

Account No: 1234567890-1

Statement Date: 09/07/2019

Due Date: 09/28/2019

Service Information

Meter#

11111111

Current Meter Reading

2,588

Prior Meter Reading

2,583

Difference

5

Multiplier

1.031647

Total Usage

5.000000 Therms

Baseline Territory

X

Serial

G

Gas Procurement Costs ($/Therm)

07/02/2019 - 07/31/2019$0.28462

Gas Usage This Period: 5.000000 Therms, 30 billing days

Therms

 

 

 

 

 

= Average Daily Usage 0. 17 I

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

7/2

7/5

7/8

7/11

7/14

7/17

7/20

7/23

7/26

7/29

 

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 5 of 6

 

ENERGY STATEMENT

Statement Date:

 

09/07/2019

 

Account No:

1234567890-1

www.pge.com/MyEnergy

Due Date:

09/28/2019

 

Important Messages (continued from page 1)

CARE Program. You may qualify for a monthly discount with the California Alternate Rates for Energy (CARE) Program. To find out more and apply online, visit www.pge.com/care.

Usted podría reunir los requisitos de un descuento mensual con el California Alternate Rates for Energy Program (CARE). Para obtener más información y hacer su solicitud en Internet, visite www.pge.com/espanol/care.

Electric power line safety PG&E cares about your safety. Be aware of your surroundings and keep yourself, tools, equipment and antennas at least 10 feet away from overhead power lines. If you see an electric power line fall to the ground, keep yourself and others away. Call 9-1-1.

Call 811 before you dig. A common cause of pipeline accidents is damage from digging. If you plan on doing any digging, such as planting a tree or installing a fence, please call 811 at least two working days before you dig. One free call will notify underground utilities to mark the location of underground lines, helping you to plan a safe project.

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 6 of 6

Documents used along the form

When managing household utilities or applying for services, several forms and documents are often required alongside a Utility Bill form. Each of these documents serves a specific purpose, helping to establish identity, residency, or financial responsibility. Below is a list of commonly used documents that complement the Utility Bill form.

  • Identification Card: A government-issued ID, such as a driver's license or passport, is essential for verifying a person's identity. This document helps service providers confirm that the applicant is who they claim to be.
  • Lease Agreement: This document outlines the terms of a rental arrangement between a landlord and tenant. It serves to prove residency and may be required to show that the individual has the right to reside at the address listed on the Utility Bill.
  • Bank Statement: A recent bank statement can be used to demonstrate financial stability. It often includes the applicant's name and address, which helps verify their residency and ability to pay for utility services.
  • Pay Stub: A pay stub provides evidence of employment and income. It can help service providers assess an applicant's financial situation, ensuring they can meet their utility payment obligations.
  • Social Security Card: While not always required, a Social Security card can be requested for identity verification. It is particularly useful in situations where a credit check may be necessary.
  • Hold Harmless Agreement: To manage potential liabilities associated with various activities, consider filling out a Hold Harmless Agreement form, such as the one available at Missouri PDF Forms.
  • Application Form: This is a standard form that collects personal information from the applicant. It typically includes details such as name, address, and contact information, which are crucial for processing utility service requests.

Having these documents ready can streamline the process of applying for utility services or resolving issues related to them. Each document plays a vital role in ensuring that the necessary information is available for verification and approval, ultimately facilitating a smoother experience for everyone involved.

Key takeaways

When it comes to filling out and using the Utility Bill form, there are several important points to keep in mind. These takeaways will help ensure that you complete the form accurately and efficiently.

  • Understand the Purpose: The Utility Bill form is typically used to verify your residency or to establish utility services in your name. Knowing its purpose helps you provide the right information.
  • Gather Necessary Information: Before starting, collect all relevant details such as your account number, service address, and billing period. Having this information on hand will streamline the process.
  • Be Accurate: Double-check all entries for accuracy. Mistakes can lead to delays in processing your request or even complications with your utility services.
  • Submit on Time: If there’s a deadline for submitting the form, make sure to adhere to it. Late submissions can result in service interruptions or additional fees.
  • Keep a Copy: After filling out the form, retain a copy for your records. This can be helpful for future reference or in case any issues arise.

By following these key takeaways, you can navigate the Utility Bill form with confidence and ease.

Form Overview

Fact Name Description
Purpose The Utility Bill form is used to document and verify utility expenses for various purposes, including financial assistance and legal proceedings.
Common Utilities This form typically covers essential services such as electricity, water, gas, and internet.
Eligibility Individuals applying for assistance programs may need to submit this form to prove their utility expenses.
Submission Requirements Most agencies require the form to be completed in full, with supporting documentation attached, such as recent bills.
State-Specific Variations Different states may have their own versions of the Utility Bill form, governed by local laws and regulations.
Privacy Considerations Personal information included in the form must be handled in accordance with privacy laws to protect the applicant's data.
Filing Deadlines Applicants should be aware of any deadlines for submitting the Utility Bill form, as these can vary by program and state.

Frequently Asked Questions

What is the Utility Bill form used for?

The Utility Bill form is primarily used to verify a person's residency and address. It serves as proof that an individual lives at a specific location, which can be important for various applications such as opening a bank account, applying for a driver's license, or registering for services. Utility bills typically include information like the account holder's name, service address, and billing period, making them a reliable source of address verification.

Who needs to fill out the Utility Bill form?

Generally, anyone who needs to provide proof of residency may be required to fill out the Utility Bill form. This includes tenants, homeowners, and even individuals who are temporarily staying at a location. If you are applying for services or benefits that require confirmation of where you live, you might need to submit this form along with a recent utility bill.

What information is required on the Utility Bill form?

The Utility Bill form usually requires the following information:

  1. Your full name
  2. The address where you reside
  3. The type of utility service (e.g., electricity, water, gas)
  4. The account number associated with the utility
  5. The billing period of the utility bill
  6. Your signature and date

Make sure all the information is accurate and up-to-date to avoid any issues during the verification process.

How recent does the utility bill need to be?

Most organizations will require a utility bill that is recent, typically within the last 30 to 60 days. This ensures that the information reflects your current residency status. Always check the specific requirements of the organization requesting the form, as they may have their own guidelines regarding the age of the bill.

Can I use any utility bill for this form?

Generally, you can use any utility bill that clearly shows your name and address. Common options include bills for electricity, water, gas, internet, or cable services. However, some organizations may specify which types of utility bills they accept, so it’s wise to confirm their requirements before submitting your form.

What if my name is not on the utility bill?

If your name does not appear on the utility bill, you may still be able to use it as proof of residency, but additional documentation may be required. For example, you could provide a letter from the account holder stating that you reside at that address. Alternatively, you might need to submit other forms of identification that link you to the residence, such as a lease agreement or bank statement with your name and address.

Where can I submit the completed Utility Bill form?

The submission process varies depending on the organization requesting the form. Typically, you can submit it in person, by mail, or electronically. Be sure to follow the specific instructions provided by the organization. If you have any doubts, don’t hesitate to reach out to them for clarification on how and where to send your completed form.

Misconceptions

Understanding the Utility Bill form can be challenging. Here are seven common misconceptions that people often have about this form:

  1. It is only for new utility services. Many believe the Utility Bill form is exclusively for initiating new services. In reality, it can also be used for changes to existing accounts, such as updating your address or changing the name on the account.
  2. Only homeowners need to fill it out. Some think that only homeowners are required to complete the Utility Bill form. Renters also need to provide this information, especially if they are responsible for utility payments as part of their lease agreement.
  3. It is the same for all utility companies. People often assume that the form is standardized across all utility providers. However, each company may have its own specific requirements and formats, which can lead to confusion.
  4. Filling it out is optional. Many individuals believe that completing the Utility Bill form is not mandatory. In fact, it is typically required to establish or modify utility services.
  5. Submitting the form guarantees service activation. There is a misconception that simply submitting the Utility Bill form will ensure immediate activation of services. Approval may take time, and additional documentation might be required.
  6. It only needs to be filled out once. Some think that once the Utility Bill form is completed, it never needs to be updated. Changes in personal circumstances, such as moving or changing account holders, may necessitate a new submission.
  7. Utility Bill forms are confidential and cannot be accessed. While personal information on the form is protected, it is not entirely confidential. Utility companies may share certain information for billing or service purposes, which can lead to concerns about privacy.

Being aware of these misconceptions can help individuals navigate the Utility Bill form process more effectively.