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[Customer’s Letterhead]
(Date)
BUSINESS CENTER
CONSUMERS ENERGY
4000 CLAY AVENUE SW
PO BOX 201
GRAND RAPIDS MI 49501-0201
Please consider this letter as a formal request to have Utility Management Services, Inc
(Supplier/Energy Manager Agent)
listed as an Authorized Agent for
(Company/Corporation)
Effective immediately, the Supplier/Energy Manager listed above is authorized to:
(Please select all that apply)
Receive historical usage and interval data
Request rate changes
Receive billing and payment information
Request account changes, including billing address
Request work orders
Request to establish or terminate accounts
(Other)
This authorization is valid for a term of months and expires on
(Date)
Service Address Account Number Tax ID
___________________________________ ___________________ _______________
___________________________________ __________________ ________________
____________________________________ ___________________
__________________
__________________________________________ ______________________ __________________
__________________________________________ ______________________ __________________
(Printed Name) (Signature)
(Title) (Email Address)
(Telephone Number)
