Homepage Fill in Your Utility Bill Template
Table of Contents

When managing household expenses, staying on top of utility bills is essential for effective budgeting and financial planning. The Utility Bill form serves as a crucial document for both service providers and consumers, ensuring that all necessary information regarding utility services is accurately captured. This form typically includes details such as the name and address of the account holder, account number, and specifics about usage levels for services like electricity, water, and gas. Information about billing cycles, payment methods, and due dates may also be present, making it easier for individuals or businesses to track their payment history and manage future expenses. In addition, the form can serve as a record for disputing charges or for requesting adjustments based on unusual usage patterns. Understanding the components of the Utility Bill form helps consumers take proactive steps toward maintaining their utility accounts effectively.

Sample - Utility Bill Form

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 [email protected]

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

File Specs

Fact Name Description
Purpose The Utility Bill form is used to document and verify household utility expenses for various needs, such as applications for assistance or verifications of residency.
Information Required The form typically requires details such as the name of the utility provider, account number, and payment history.
Frequency of Use This form is often required on a monthly or quarterly basis, depending on the circumstances it is needed for.
State-Specific Forms Different states may have their own versions of the Utility Bill form, which may include additional regulations. For example, in California, it is governed by the Public Utilities Code.
Filing Instructions Completed forms must be filed with the appropriate agency or organization, as specified in the application guidelines.
Deadline It is crucial to submit the form before the application deadline to ensure eligibility for programs that require it.

Utility Bill - Usage Guidelines

Filling out the Utility Bill form is an important step towards ensuring that your payments and services are managed effectively. Taking your time with this process will help prevent any potential delays or issues with your utility services. Please follow the steps outlined below to complete the form accurately and efficiently.

  1. Begin by placing the Utility Bill form in front of you on a flat surface.
  2. At the top of the form, enter your full name in the designated space.
  3. Next, provide your current residential address, including the street, city, state, and zip code.
  4. Locate the section for utility service information and fill in the name of the utility company.
  5. Input your account number, which can usually be found on your previous utility bill.
  6. In the next field, write the date of your last payment to help keep your records straight.
  7. Check off any relevant boxes that pertain to your service type if applicable.
  8. Carefully review all the information to ensure it is correct and complete.
  9. Finally, sign and date the form at the bottom to confirm that all the details are accurate.

Your Questions, Answered

What is the Utility Bill form?

The Utility Bill form is a document used to report and keep records of utility expenses. This may include bills for water, gas, electricity, and sewage services. Properly filling out this form can be essential for budgeting or applying for certain services where proof of utility payments is required.

Who needs to fill out the Utility Bill form?

Anyone who is responsible for paying utility bills may need to fill out this form. This includes homeowners, renters, and businesses. It is often required for assistance programs or for verification in financial transactions.

What information is required on the Utility Bill form?

The form typically requires details such as the names of the utility providers, account numbers, billing addresses, payment due dates, and total amounts due. Make sure to also include any past due amounts if applicable.

Is there a deadline to submit the Utility Bill form?

Deadlines may vary based on your specific needs or the purpose of the form. If you are using it for an assistance program, check their guidelines for timely submission. It's best to submit the form as soon as you have all necessary information gathered.

Can I submit the Utility Bill form electronically?

Many organizations accept electronic submissions, while others may require a paper form. Check the requirements of the entity you are submitting it to. If electronic submission is allowed, you may be able to upload scanned copies of your utility bills.

What happens if I submit the Utility Bill form with missing information?

Submitting the form with incomplete information may lead to delays or rejections. The reviewing entity might reach out for the missing information, or they may discard your application altogether. It’s important to review everything carefully before submission.

Can I update the Utility Bill form after I submit it?

Once submitted, updating the Utility Bill form depends on the policies of the receiving organization. Many will allow you to submit corrections or updates. Contact them directly to inquire about their processes for updates.

What should I do if I don’t have a physical copy of my utility bill?

If a physical copy is unavailable, you can usually access your utility bill online through the provider’s website. Most utility companies offer secure online access where you can download or print your bills. If needed, customer service may also assist you in obtaining a copy.

Where can I find the Utility Bill form?

You can typically find the Utility Bill form on websites for various local agencies, utility companies, or financial assistance programs. If you’re unsure where to start, a quick search online or a call to the relevant organization can direct you to the correct source.

What should I do if I need assistance completing the Utility Bill form?

If you require help, consider reaching out to community organizations, friends, or family members who may have experience with this form. There are also many online resources that can provide guidance or even offer step-by-step assistance.

Common mistakes

  1. Incorrect Account Number: One of the most common mistakes is entering the wrong account number. This can lead to delays in processing the bill or misapplication of payments.

  2. Missing Contact Information: Failing to provide accurate contact details can hinder communication. Ensure that a current phone number or email address is included.

  3. Error in Payment Amount: Calculating the wrong amount due is frequent, particularly if customers do not verify the current balance. Double-check the figures before submitting.

  4. Neglecting to Sign the Form: Many forms require a signature to be valid. Forgetting to sign can result in disapproval or processing delays.

  5. Using Incorrect Payment Method: Different utility providers may accept various payment methods. Choosing an unacceptable method can cause complications in bill payment.

  6. Failure to Provide Additional Documents: Some utilities may require supplementary documentation. Omitting these can lead to incomplete applications.

  7. Wrong Address for Service: It's vital to ensure that the service address matches the one on file. Incorrect addresses can delay service or payment allocation.

  8. Ignoring Deadlines: Utility bills often have specific payment deadlines. Missing a deadline can result in late fees or service interruptions.

  9. Failure to Update Information: Life changes, such as moving or changes in personal information, require updates. Stale information can create complications.

Documents used along the form

A utility bill form is often accompanied by several other important documents. These documents can serve various purposes, such as verifying identity, confirming service arrangements, or providing additional financial information. Understanding these associated forms can facilitate smoother transactions and clearer communication. Below are some common documents that are frequently used alongside utility bill forms.

  • Identification Card: This document verifies the identity of the individual submitting the utility bill form. It can include a driver's license, state ID, or passport.
  • Proof of Residency: This may consist of additional documents like a lease agreement or property deed, which establish where the individual resides.
  • Income Verification: Forms such as pay stubs or tax returns may be required to confirm the individual's income level, especially when applying for assistance programs.
  • Service Agreement: This document outlines the terms and conditions of the utility service. It details the services included, costs, and the responsibilities of both the provider and the consumer.
  • Authorization Form: If someone is handling the utility bill on behalf of another person, an authorization form may be necessary to grant permission for that individual to manage the account.
  • Payment Records: Previous payment history can be requested to demonstrate reliability and good standing with the utility provider.

Gathering these documents ahead of time can streamline the process of handling utility bills and related applications. By being prepared, individuals can ensure that their submissions are complete, which may lead to quicker resolutions and approvals.

Similar forms

A lease agreement is a formal document that outlines the terms between a landlord and a tenant. It specifies the duration of the tenancy, monthly rent, and the responsibilities of both parties. Much like a utility bill, it serves as proof of residency and can be requested for identity verification or eligibility for various services. A lease often includes utilities in its terms, linking it closely to utility bills as both address living arrangements.

A bank statement provides a summary of an individual’s financial activity for a specific period. It details deposits, withdrawals, and current balances. Similar to a utility bill, it contains the account holder's name and address, serving as proof of residence or financial stability when applying for loans or services. Both documents require accuracy and often need to be recent to be relevant for verification purposes.

A pay stub offers a breakdown of an employee's earnings, including hours worked, gross pay, deductions, and net pay. It serves a similar purpose to a utility bill in that it confirms employment status and income. This document is often required when applying for loans or leases, where proof of income and residency is crucial for approval.

An insurance policy declaration page presents key information about an insurance policy, including the insured's name, coverage period, and premium amounts. Similar to a utility bill, it serves as verification of residence and can be used when applying for other services or benefits. Both documents indicate the responsibility and commitment of an individual or household.

A government-issued ID, such as a driver's license, includes essential identifying information, such as a name and residential address. It is often required alongside a utility bill for verification processes when establishing identity for various applications. Both serve as vital documents in confirming identity and residency, making them integral in legal and administrative matters.

Dos and Don'ts

When filling out a Utility Bill form, keeping a few key points in mind can make the process smoother and help avoid potential issues.

Things You Should Do:
  • Read the instructions carefully before starting the form.
  • Provide accurate information, including your account number and billing address.
  • Double-check your entries for any spelling or numerical errors.
  • Keep a copy of the completed form for your records.
  • Submit the form within the specified time frame to avoid late fees.
  • Contact customer service if you have questions about filling out the form.
  • Include any required documentation or proof of identity as requested.
Things You Shouldn't Do:
  • Don't leave any required fields blank.
  • Avoid using nicknames or informal titles in the personal information section.
  • Don't submit the form without verifying the accuracy of your information.
  • Do not ignore deadlines; late submissions can result in service interruptions.
  • Refrain from providing misleading information, even accidentally.
  • Don't forget to sign and date the form where needed.
  • Avoid submitting the form via an insecure method; opt for reliable delivery options.

Misconceptions

The Utility Bill form is often surrounded by confusion. Many people hold misconceptions that can lead to misunderstandings regarding its purpose and use. Below are seven common misconceptions, each clarified for better understanding.

  1. The Utility Bill form is only for new accounts. In reality, this form is used for both new accounts and to update existing account information. Customers may need to submit the form for various reasons, such as changing addresses or billing information.
  2. All utility companies require the same form. Each utility company may have its own specific form and requirements. It's important for customers to verify the specific form needed for their utility provider.
  3. Filling out the form incorrectly will automatically result in denial. While accuracy is important, most utility companies will contact customers for clarification or request corrections rather than outright deny the form.
  4. The form can be submitted at any time. Some utility companies have specific submission windows. Check the company’s guidelines to ensure timely processing of your request.
  5. The Utility Bill form only applies to residential customers. This form can also be used by commercial accounts. Businesses may need to provide utility bills to establish or manage their services.
  6. Once submitted, the information will never change. Utility customers can submit updates to their information as needed. Changing circumstances may require new forms over time.
  7. Utility companies do not keep records of submitted forms. Utility providers maintain records of all submitted forms for their reference. This ensures they can resolve any issues that arise regarding account status.

Understanding these misconceptions can help customers navigate the process of using the Utility Bill form more effectively, ensuring smoother transactions with their utility providers.

Key takeaways

Here are some key takeaways regarding the Utility Bill form:

  1. Ensure all personal information is accurate and up-to-date, including your name and address.
  2. Provide the correct account number, as this helps in verifying your identity with the utility provider.
  3. Complete the form thoroughly; missing information may result in processing delays.
  4. Keep a copy of the completed form for your records, in case of future inquiries.
  5. Submit the form through the recommended channel, whether it is online, by mail, or in person.
  6. Check for submission deadlines. Ensure your form is submitted on time to avoid service disruptions.
  7. Review any additional requirements that may apply depending on your utility provider.
  8. Monitor your utility bill after submission; discrepancies should be reported immediately.
  9. Utilize customer service resources if you encounter issues or have questions about the form.