- Please put your first name in this box.
- Please put the first letter of your middle name in this box followed by a "."
- Please put your last name in this box.
Mailing Address (required field)
- This refers to your U.S. mail mailing address. There are 3 lines available for this information. Please do not put your suite number, floor number, or apartment number in this box.
-If you are entering a nine digit zip code, please us a "-" between the fifth and sixth digits.
Home Telephone Number (Voice)- Please enter your telephone number the following format: (XXX)XXX-XXXX.
Alternative Telephone Number
- Please enter the phone number where you can be reached between 8 AM and 5 PM. Use the following format: (XXX)XXX-XXXX.
- Please enter your fax number here in the following format: (XXX)XXX-XXXX.
- Please provide your e-mail address in this line.
Name on Account
- The name of the person on the service bill goes in this space.
- The location where you are experiencing difficulty goes here. If the service address and the mailing address are the same, please leave this space blank. If you are a business and have multiple locations, please put the service address of the location of the property where you are experiencing difficulty.
- This is the phone number of the location where you are experiencing difficulty. If you have multiple phone numbers or are a business that has multiple locations, please put the phone number in of the location/line you are having trouble with.
- Your account number can be found on your utility bill.
-Please put the name of the utility company with which you are having a problem.
Name of Utility Service Territory
- If you have made the decision to switch electric or gas suppliers, the name of the company who provides the gas pipeline (local gas distribution company) or electric wire (local electric utility) to your residence/business should go here (with the name of the gas marketer or electric supplier in the Utility Company field above). (If you have not signed a contract to switch your gas or electric, please leave this field blank.)
Details of Concerns
- Please provide the details of your comments, question, or complaint. This field is only 6000 spaces long. Please provide as many dates and details as possible. The more specific information we have, the better able we will be to process your concerns/questions.