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actions, causes of action, suits, damages, losses, expenses or attorney’s fees of any kind and every nature whatsoever,
known or unknown, resulting from: (a) any release of information to Agent pursuant to this Authorization; (b) the
unauthorized use of this information by Agent; and (c) from any actions taken by Agent pursuant to this Authorization,
including but not limited to rate changes and contract modifications.

6. No Third Party Beneficiaries. No provision of this Agreement is intended or shall be construed to be for the benefit of any
third party.

7. Notices. Dominion Energy contact for Revocation of Notices or any other communications under this Agreement is as
follows:

Dominion Energy South Carolina, Inc.
Legal Department, MC C222
220 Operation Way
Cayce, SC 29033-3701
Dominion Energy Account Representative: ________________________

I, ___________________________________ (print or type name), declare under penalty of perjury under the laws of the
State of South Carolina that I am authorized to execute this document on behalf of Customer and that I have authority to
contractually and financially bind the Customer. I further authorize Agent to act on Customer’s behalf pursuant to this
Agreement. I understand that Dominion Energy reserves the right, but is not obligated, to verify any Authorization for
Agency request submitted before releasing information or taking any action. I further agree to all the terms as set forth in
this document.

Customer Signature Printed Name and Title
Billing Address City, State, and Zip Code

Telephone Number City and State

Executed this day of , 20__ at //

Month

FOR INTERNAL USE ONLY: A t( )
A t dt C t

Customer Designation & Authorization of Agency Page 3 of 3 October 11, 2010
Form Dominion Energy 08-011