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Utility Bill PDF Form

The Utility Bill form is a document used to detail the charges for services such as electricity, water, gas, and other utilities provided to a residence or business. This form serves as a crucial tool for both consumers and utility companies, facilitating accurate billing and payment processing. Understanding the components of this form can help individuals manage their utility expenses more effectively.

Customize Utility Bill

Customize Utility Bill

Table of Contents

The Utility Bill form plays a crucial role in managing household expenses and ensuring that essential services remain uninterrupted. This form typically includes vital information such as the account holder's name, service address, and billing period, which are necessary for accurately processing payments. It often outlines the specific utilities being billed, such as water, electricity, and gas, along with their respective usage details. Additionally, payment options and due dates are clearly specified, allowing customers to plan their finances accordingly. By understanding the various components of the Utility Bill form, individuals can better navigate their responsibilities and avoid potential service disruptions. This form serves not only as a record of consumption but also as a reminder of the importance of timely payments in maintaining essential services.

Common mistakes

Incorrect Account Number: Many people mistakenly enter the wrong account number. This can lead to delays in processing and even missed payments.
Missing Personal Information: Failing to provide complete personal information, such as your name or address, can cause confusion and prevent the utility company from identifying your account.
Failure to Sign: Some individuals forget to sign the form. Without a signature, the form is often considered invalid.
Incorrect Payment Amount: Entering the wrong payment amount can result in either overpayment or underpayment, which complicates future billing.
Not Checking for Updates: Utility rates can change. Not checking for the latest rates before filling out the form can lead to inaccuracies.
Neglecting to Review: Skipping the review process can lead to easily fixable mistakes. Always double-check your entries before submission.

Example - Utility Bill Form

ENERGY STATEMENT	Account No:	1234567890-1
ENERGY STATEMENT	Statement Date:	09/07/2019
www.pge.com/MyEnergy	Due Date:	09/28/2019
www.pge.com/MyEnergy

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
$200								Ago	Period	Period
$150								12.50	12.16	12.67
$100								■ ■ ■
$50								Electric kWh / Day
$50
$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
ENERGY STATEMENT	Statement Date:	09/07/2019
www.pge.com/MyEnergy	Due Date:	09/28/2019
www.pge.com/MyEnergy

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

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#	1111111111
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						= 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
	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

More About Utility Bill

What is the Utility Bill form used for?

The Utility Bill form is typically used to verify a person's residency or address. It serves as proof of where an individual lives, which can be necessary for various applications, such as obtaining a driver's license, enrolling in school, or applying for government assistance programs.

Who needs to fill out the Utility Bill form?

Individuals who need to provide proof of residency may be required to fill out this form. This includes, but is not limited to, new residents, students, or anyone applying for services that require address verification.

What information is required on the Utility Bill form?

The form typically asks for personal details such as your name, current address, and possibly other identifying information. Additionally, you may need to provide details about the utility service, including the account number and the billing address, if different from your residence.

How do I obtain a Utility Bill form?

You can usually obtain the Utility Bill form from your local government office, utility company, or online through official websites. Some organizations may also provide a downloadable version of the form for convenience.

Is there a fee associated with the Utility Bill form?

Generally, there is no fee for filling out the Utility Bill form itself. However, if you need to obtain a copy of your utility bill from the service provider, there may be associated costs depending on their policies.

How do I submit the Utility Bill form once completed?

Submission methods vary depending on the organization requesting the form. You may need to submit it in person, via mail, or electronically through an online portal. Always check the specific instructions provided by the entity requiring the form.

Can I use a digital copy of my Utility Bill?

Many organizations accept digital copies of utility bills, especially if they are printed directly from your utility provider's website. However, it’s important to confirm with the requesting entity whether they accept digital submissions and if any specific format is required.

What should I do if my Utility Bill is not in my name?

If the utility bill is not in your name, you may need to provide additional documentation to verify your residency. This could include a notarized letter from the bill holder or other forms of identification that link you to the address.

How long does it take to process the Utility Bill form?

Processing times can vary widely depending on the organization and the volume of requests they receive. Typically, you can expect a response within a few days to a couple of weeks. If you have a time-sensitive matter, it is advisable to inquire about expedited processing options.

Key takeaways

When filling out and using the Utility Bill form, keep these key points in mind:

Accurate Information: Ensure all details are correct. Double-check names, addresses, and account numbers to avoid delays.
Required Documents: Gather any necessary documents before starting the form. This may include identification and proof of residence.
Read Instructions: Carefully read any instructions provided with the form. Understanding the requirements can save time.
Submission Method: Know how to submit the form. Whether by mail, online, or in-person, follow the specified guidelines.
Deadlines: Be aware of any deadlines for submission. Late submissions could lead to penalties or service interruptions.
Keep Copies: Always keep a copy of the completed form for your records. This can be useful for future reference.
Contact Information: Include accurate contact information. This allows for quick follow-up if there are questions about your submission.
Follow Up: After submitting, follow up to ensure your form was received and processed. This can help prevent any issues.

Taking these steps will help ensure a smooth experience with the Utility Bill form.

Form Attributes

Fact Name	Description
Purpose	The Utility Bill form is used to document and request utility services for residential or commercial properties.
Common Utilities	This form typically covers services such as electricity, water, gas, and internet.
Information Required	Users must provide personal information, service address, and billing preferences.
State-Specific Forms	Some states have specific forms governed by local laws. For example, California follows the Public Utilities Code Section 1001.
Submission Process	The completed form can usually be submitted online, by mail, or in person at the utility provider's office.
Fees	Some utility providers may charge a fee for processing the Utility Bill form, depending on the service requested.
Importance of Accuracy	Providing accurate information is crucial to avoid delays in service activation or billing errors.

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Dos and Don'ts

When filling out a Utility Bill form, it’s important to be thorough and accurate. Here’s a list of dos and don’ts to guide you through the process.

Do double-check your account number for accuracy.
Do provide your current address clearly and completely.
Do include your contact information, such as phone number and email.
Do review the payment options available before submitting.
Do keep a copy of the completed form for your records.

Don't leave any required fields blank.
Don't use abbreviations that could lead to confusion.
Don't forget to sign and date the form, if required.
Don't submit the form without reviewing it for errors.

By following these guidelines, you can ensure that your Utility Bill form is filled out correctly, helping to avoid any potential issues with your utility provider.