Download Utility Bill Form in PDF
The Utility Bill form serves as a crucial document for individuals and businesses alike, playing a vital role in the management and payment of utility services. It typically includes essential information such as the account holder's name, service address, billing period, and detailed breakdown of charges for services rendered, including electricity, water, gas, and other utilities. Understanding the components of this form is imperative, as it can impact budgeting and financial planning. Moreover, the form often contains important instructions for payment methods, deadlines, and potential penalties for late payments. In addition, many utility companies provide options for electronic billing and payment, which can simplify the process for consumers. As energy costs fluctuate, being well-informed about the Utility Bill form can empower individuals to make better financial decisions and ensure timely payments, thus avoiding service interruptions. Recognizing the significance of this document is not just about meeting obligations; it also involves understanding one's rights and responsibilities as a consumer in the utility marketplace.
Document Data
| Fact Name | Description |
|---|---|
| Purpose | The Utility Bill form is used to document and verify utility expenses for various purposes, including financial assistance applications and residency verification. |
| Common Utilities | This form typically covers essential services such as electricity, water, gas, and sometimes internet or cable services. |
| Required Information | Applicants must provide details such as the utility provider's name, account number, billing address, and the total amount due. |
| State-Specific Forms | Some states have specific forms or requirements. For example, California's utility assistance programs may reference the California Public Utilities Code. |
| Submission Methods | Forms can often be submitted electronically, by mail, or in person, depending on the agency's guidelines. |
| Verification Process | Utility companies may need to verify the information provided on the form before any assistance is granted. |
| Deadline | Each program may have its own deadlines for submission, so it’s crucial to check specific requirements to ensure timely processing. |
How to Write Utility Bill
Completing the Utility Bill form is a straightforward process. Once you have filled it out, you will be ready to submit it for processing. Ensure that all information is accurate to avoid any delays.
- Gather all necessary information such as your account number, service address, and billing period.
- Begin by entering your name in the designated field.
- Provide your current address, ensuring it matches the address on your utility bill.
- Fill in your account number, which can be found on your utility bill.
- Indicate the billing period for which you are submitting the form.
- Check the box if you are requesting assistance or if there are any special circumstances.
- Review all the information for accuracy.
- Sign and date the form at the bottom.
- Submit the completed form through the specified method, whether online or by mail.
Utility Bill Example
ENERGY STATEMENT |
Account No: |
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Statement Date: |
09/07/2019 |
|
www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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Service For:
SPARKY JOULE 12345 ENERG'( CT
Questions about your bill?
Ways To Pay
www.pge.com/waystopay
Your Account Summary
Amount Due on Previous Statement |
$91.57 |
Payment(s) Received Since Last Statement |
|
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 |
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Daily Usage Comparison |
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$200 |
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1 Year |
Last |
Current |
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Ago |
Period |
Period |
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$150 |
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12.50 |
12.16 |
12.67 |
$100 |
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$50 |
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Electric kWh / Day |
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$0 |
0.12 |
0.16 |
0.17 |
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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 |
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■ |
Electric |
D |
Gas |
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Gas Therms/ Day |
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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
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
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: |
|
09/28/2019 |
$88.14 |
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$ |
PG&E
BOX 997300
SACRAMENTO, CA
Page 1 of 6
ENERGY STATEMENT |
Account No: |
|
Statement Date: |
09/07/2019 |
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www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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Important Phone Numbers -
TTY
Servicio al Cliente en Espanol (Spanish)
Djch VI) khach tieng Vi�t (Vietnamese) |
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Business Customer Service |
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
If you believe there is an error on your bill, please call
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
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
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
Gas Public Purpose Program (PPP) Surcharge. Used to fund
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 |
|
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 |
|
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
Account Number:
Change my mailing address to: ________________
City _____________ State |
ZIP code ____ |
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Primary |
Primary |
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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
•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
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
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 |
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Power Charge Indifference Adjustment |
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10.26 |
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Franchise Fee Surcharge |
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0.25 |
Total PG&E Electric Delivery Charges |
$55.66 |
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Electric Usage This Period: 380.000000 kWh, 30 billing days |
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30kWh |
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Average Daily Usage 12.67 I |
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18 |
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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 |
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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: |
$32.37 |
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Generation - Total |
380.000000 kWh @$0.08519 |
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Net Charges 32.37 |
0. 11 |
Energy Commission Surcharge |
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Customers receive clean electricity and save money with SVCE. Please see updated |
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SVCE electric rates and comparisons to PG&E at www.svcleanenergy.com/rates |
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Total Silicon Valley Clean Energy |
$32.48 |
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Electric Generation Charges |
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Account No: |
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Statement Date: |
09/07/2019 |
Due Date: |
09/28/2019 |
Service Information |
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Total Usage |
380.000000 kWh |
For questions regarding charges on this page, please contact:
SILICON VALLEY CLEAN ENERGY
Additional Messages
About Silicon Valley Clean Energy (SVCE) Serving 13 Santa Clara County communities, SVCE is a
Understanding SVCE Charges
PG&E continues to provide and bill for electric delivery. SVCE replaces PG&E generation charges. Under PG&E Electric Delivery Charges, note the Generation Credit. This is what PG&E would have charged for power, and now credits back to you. The Power Charge Indifference Adjustment and Franchise Fee are factored into SVCE rates. Learn more:
SVCE is committed to protecting customer privacy.
Learn about our privacy policy at
Visit www.pge.com/MyEnergy for a detailed bill comparison. |
Page 4 of 6 |
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ENERGY STATEMENT
www.pge.com/MyEnergy
Details of Gas Charges
08/02/2019 - 08/31/2019 (30 billing days)
Service For: 12345 ENERGY CT
Service Agreement ID: 1111111111
Rate Schedule: G1 X Residential Service
07/02/2019 - 07/31/2019 |
Your Tier |
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Tier 1 Allowance |
17.70 Therms (30 days x |
0.59 Therms/day) |
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Tier 1 Usage |
5.000000Therms @$ 1.28395 |
$6.42 |
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Gas PPP Surcharge ($0.09047 /Therm) |
0.45 |
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Total Gas Charges |
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$6.87 |
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Account No:
Statement Date: 09/07/2019
Due Date: 09/28/2019
Service Information
Meter# |
11111111 |
Current Meter Reading |
2,588 |
Prior Meter Reading |
2,583 |
Difference |
5 |
Multiplier |
1.031647 |
Total Usage |
5.000000 Therms |
Baseline Territory |
X |
Serial |
G |
Gas Procurement Costs ($/Therm)
07/02/2019 - 07/31/2019$0.28462
Gas Usage This Period: 5.000000 Therms, 30 billing days
Therms |
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= Average Daily Usage 0. 17 I |
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7/2 |
7/5 |
7/8 |
7/11 |
7/14 |
7/17 |
7/20 |
7/23 |
7/26 |
7/29 |
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Visit www.pge.com/MyEnergy for a detailed bill comparison. |
Page 5 of 6 |
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ENERGY STATEMENT |
Statement Date: |
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09/07/2019 |
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Account No: |
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www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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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
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
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