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Duke Energy Carolinas, LLC
Customer Authorization for Disclosure of Customer Information
Permission is hereby granted to the third party/consultant, as identified below, to act as my/our
agent and to obtain copies of all available billing history and Customer Service Records,
including on-line access to account information, and to initiate rate change requests on the
Customer’s behalf for the account number(s) shown below from Duke Energy Carolinas, LLC.
Third Party/Consultant:
Name: Utility Management Services, Inc., and it’s representatives
Contact: Brian Coughlan, President
Email: bcoughlan@utilmanagement.com
Ph: 888-867-3230 x102 Fax: 910-793-2946
Mailing Address: 6317 Oleander Drive, Ste C. Wilmington, NC 28403
This authorization will remain in effect for a period of 36 months after the date of signature of
this authorization, and may also be revoked at any time by notifying Duke Energy Carolinas,
LLC in writing of such revocation at the following address:
Duke Energy
C/O Customer Service
P.O. Box 1090
Charlotte, NC 28201-1090
Signature: _________________________ Date: ___________________
Name: ____________________________ Title: ___________________
EIN: _______________________________________________________
Customer Legal Name _________________________________________
Contact Ph: ___________ Fax: ___________ Email: _________________
Mailing Address: ______________________________________________
Duke Energy Account Number (attach additional Name as it appears on bill
sheets if necessary)
Rev. 5/2019
