Building Energy Use & Public Disclosure Program
I authorize Azusa Light & Water (ALW) to release and deliver the historic energy use data for the utility service accounts listed on the attached form to the Owner of the associated building(s), as required for participation in the Building Energy Use Date and Public Disclosure Program. This data release consent form will remain active until withdrawn in writing by myself, my designee, or any new tenant of the associated property or facility.
Consumer Energy Data Release Form
Name that Appears on ALW Bill:
*
Provide Last 4 of SSN or Federal Tax ID on ALW Account:
*
Provide ALW Account Number(s):
Provide Service Address(es) that Appears on ALW Bill:
For Business Accounts- Provide Full Name of Authorized Person Acting on Behalf of Company:
First Name
Last Name
For Business Accounts- Provide Title of Authorized Person:
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Date Range for the Requested Data
From:
*
-
Month
-
Day
Year
Date
To:
*
-
Month
-
Day
Year
Date
Consent
Signature:
*
Today's Date
*
Submit
Should be Empty: