Upstate Utilities & Consultants Inc.
Authorization to Release
Electric & Natural Gas Data

I authorize Upstate Utilities & Consultants Inc. to request on my behalf, 24 months energy usage related to the account(s) listed below.


Referred by
Requesting service on
Service Address #1:
City
State/Zip
National Grid Acct. #

 
Service Address #2:
City
State/Zip
National Grid Acct. #
 
Service Address #3:
City
State/Zip
National Grid Acct. #
 
Service Address #4:
City
State/Zip
National Grid Acct. #
 
Name (Residential)
Company Name
Contact
Contact Phone
Title
Email
Billing Address
City
State/Zip
Signature Date
 

You may submit this information and a representative will contact you or you can print this form, sign it and fax it to our office at 518-842-6131.

Daniel Russo
sales@upstateutilities.com


Upstate Utilities & Consultants, Inc.
Daniel Russo • President & Owner
4720 State Highway 30 • Amsterdam, NY 12010
Tel: 518.842.6130 • Fax: 518.842.6131
E-mail: sales@upstateutilities.com
www.upstateutilities.com