Authorization To: Receive Customer Information or Act on a ... 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and title (if applicable) in the designated fields. This identifies you as the customer granting authorization.
3. Fill in your mailing address accurately to ensure proper communication regarding your account.
4. Next, appoint your agent by entering their name and mailing address. This person will act on your behalf for the specified accounts.
5. List the service addresses and account numbers for all accounts included in this authorization. If you have more than three, attach a separate sheet.
6. Initial next to each specific act or function you authorize your agent to perform, such as requesting billing records or rate changes.
7. Select the type of authorization period that suits your needs—one-time, one year, or up to three years—and fill in any required dates.
8. Indicate your preferred format for receiving information by checking the appropriate boxes for hard copy, fax, or electronic mail.
9. Finally, sign and date the form at the bottom, ensuring that someone with authority is signing on behalf of the customer.

Start using our platform today to streamline your document editing and form completion process for free!