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Fillable Utility Bill Template

The Utility Bill form is a document used to request or verify utility services such as water, electricity, or gas. This form serves as a critical tool for both consumers and service providers, ensuring accurate billing and service delivery. To get started, fill out the form by clicking the button below.

Get My Utility Bill

Get My Utility Bill

Content Overview

File Details

Fact Name	Description
Purpose	The Utility Bill form is used to document the consumption of utilities such as water, electricity, and gas.
Common Uses	This form is often required for establishing service, verifying residency, or applying for financial assistance programs.
State-Specific Variations	Different states may have specific requirements or formats for their Utility Bill forms, reflecting local regulations.
Governing Laws	In many states, utility billing practices are governed by state public utility commissions, which set regulations on billing accuracy and consumer rights.
Information Required	Typically, the form includes details such as the name of the account holder, service address, account number, and billing period.
Submission Process	Utility Bill forms may need to be submitted online, by mail, or in person, depending on the utility provider's policies.
Payment Options	Many utility companies offer various payment options, including online payments, automatic withdrawals, and in-person payments.
Dispute Resolution	If there are discrepancies in the bill, consumers can often file a dispute through the utility provider's customer service department.
Confidentiality	Utility Bill forms typically contain personal information, and providers must adhere to privacy laws to protect customer data.

Sample - Utility Bill Form

ENERGY STATEMENT	Account No:	1234567890-1
ENERGY STATEMENT	Statement Date:	09/07/2019
www.pge.com/MyEnergy	Due Date:	09/28/2019
www.pge.com/MyEnergy

Service For:

SPARKY JOULE 12345 ENERG'( CT

Questions about your bill?

Monday-Friday 7 a.m.-9 p.m. Saturday 8 a.m.-6 p.m. Phone: 1-800-743-5000 www.pge.com/MyEnergy

Ways To Pay

www.pge.com/waystopay

Your Account Summary

Amount Due on Previous Statement	$91.57
Payment(s) Received Since Last Statement	-91.57
Previous Unpaid Balance	$0.00
Current PG&E Electric Delivery Charges	$55.66
Silicon Valley Clean Energy Electric Generation Charges	$32.48
I Total Amount Due by 08/28/2019	$88.14

Monthly Billing History								Daily Usage Comparison
$200								1 Year	Last	Current
$200								Ago	Period	Period
$150								12.50	12.16	12.67
$100								■ ■ ■
$50								Electric kWh / Day
$50
$0	-+-----'-r-"-------	"'r�---	'-r"-----'-r-"	-----'-r�---	'-r"-----'-r"----'-r�---		'--r"------'-r"------i	0.12	0.16	0.17
2018 8/07		9/06 10/04 11/06 12/06 1/08 2/06			3/07 4/08	5/09 6/06	7/10 8/07 2019-�c____<=----			=::,__---l
			■	Electric	D	Gas		Gas Therms/ Day

Visit www.pge.com/MyEnergy for a detailed bill comparison

Important Messages

The Family Electric Rate Assistance (FERA) Program provides a monthly discount on electric bills for income-qualified households of three or more persons. To see if you qualify, please call 1-800-PGE-5000 or apply online at www.pge.com/fera.

El Programa FERA ofrece ahorros mensuales solo en las facturas de electricidad a hogares de ingresos econ6micos bajos y medianos con tres o mas personas. Para determinar si califica, por favor llame al 1-800-PGE-5000 o puede aplicar a traves de nuestra pagina web www.pge.com/fera.

Continued on page 6

Please return this portion with your payment. No staples or paper clips. Do not fold. Thank you.

Account Number:	Due Date:	Total Amount Due:	Amount Enclosed:
123456789-1	09/28/2019	$88.14
			$

PG&E

BOX 997300

SACRAMENTO, CA 95899-7300

Page 1 of 6

ENERGY STATEMENT	Account No:	1234567890-1
ENERGY STATEMENT	Statement Date:	09/07/2019
www.pge.com/MyEnergy	Due Date:	09/28/2019
www.pge.com/MyEnergy

Important Phone Numbers - Monday-Friday 7 a.m.-9 p.m., Saturday 8 a.m.-6 p.m. Customer Service (All Languages; Relay Calls Accepted) 1-800-743-5000

TTY 7-1-1

Servicio al Cliente en Espanol (Spanish) -��.P�IHf (Chinese)

1-800-660-6789	Djch VI) khach tieng Vi�t (Vietnamese)	1-800-298-8438
1-800-893-9555	Business Customer Service	1-800-468-4743

Rules and rates

You may be eligible for a lower rate. To learn more about optional rates or view a complete list of rules and rates, visit www.pge.com or call 1-800-743-5000.

If you believe there is an error on your bill, please call 1-800-743-5000 to speak with a representative. If you are not satisfied with our response, contact the California Public Utilities Commission (CPUC), Consumer Affairs Branch (CAB), 505 Van Ness Avenue, Room 2003, San Francisco, CA 94102, 1-800-649-7570 or 7-1-1 (8:30 AM to 4:30 PM, Monday through Friday) or by visiting www.cpuc.ca.gov/complaints/.

To avoid having service turned off while you wait for the outcome of a complaint to the CPUC specifically regarding the accuracy of your bill, please contact CAB for assistance. If your case meets the eligibility criteria, CAB will provide you with instructions on how to mail a check or money order to be impounded pending resolution of your case. You must continue to pay your current charges while your complaint is under review to keep your service turned on.

If you are not able to pay your bill, call PG&E to discuss how we can help. You may qualify for reduced rates under PG&E's CARE program or other special programs and agencies may be available to assist you. You may qualify for PG&E's Energy Savings Assistance Program which is an energy efficiency program for income-qualified residential customers.

Important definitions

Rotating outage blocks are subject to change without advance notice due to operational conditions.

Tier 1/Baseline allowance: Some residential rates are given a Tier 1/Baseline allowance - a CPUC approved percentage of average customer usage during summer and winter months. Your Tier 1/Baseline allowance provides for basic needs at an affordable price and encourages conservation. Your allowance is assigned based on the climate where you live, the season and your heat source. As you use more energy, you pay more for usage. Any usage over your baseline allowance will be charged at a higher price.

High Usage: An increased price per kWh whenever electricity usage exceeds four times the Baseline Allowance (Tier 1) in a billing period. This charge does not apply to Time-of-Use rate plans.

DWR bond charge: Recovers the cost of bonds issued by the Department of Water Resources (DWR) to purchase power to serve electric customers during the California energy crisis. DWR bond charges are collected on behalf of DWR and do not belong to PG&E.

Power Charge Indifference Adjustment (PCIA): Ensures that non-exempt customers under PG&E's GT and ECR rate schedules or who purchase electricity (generation) from non-PG&E suppliers pay their share of generation costs.

Gas Public Purpose Program (PPP) Surcharge. Used to fund state-mandated gas assistance programs for low-income customers, energy efficiency programs, and public-interest research and development.

Visit www.pge.com/billexplanation for more definitions. To view most recent bill inserts including legal or mandated notices, visit www.pge.com/billinserts.

Your Electric Charges Breakdown

Conservation Incentive	-$9.50
Transmission	12.42
Distribution	35.08
Electric Public Purpose Programs	4.71
Nuclear Decommissioning	0.33
DWR Bond Charge	1.91
Competition Transition Charges (CTC)	0.42
Energy Cost Recovery Amount	-0.22
PCIA	10.26
Taxes and Other	0.25
Total Electric Charges	$55.66

Update My Information (English Only)

Please allow 1-2 billing cycles for changes to take effect

Account Number: 1234567890-1

Change my mailing address to: ________________

City _____________ State		ZIP code ____
Primary	Primary

Phone#--------- Email --------------

Ways To Pay

•Online via web or mobile at www.pge.com/waystopay

•By mail: Send your payment along with this payment stub in the envelope provided.

•By debit card, Visa, MasterCard, American Express, or Discover: Call

877-704-8470 at any time. (Our independent service provider charges a fee per transaction.)

•At a PG&E payment center or local office: To find a payment center or local office near you, please visit www.pge.com or call 800-743-5000. Please bring a copy of your bill with you.

Page 2 of 6

ENERGY STATEMENT

Details of PG&E Electric Delivery Charges

Service For: 12345 ENERGY CT

Service Agreement ID: 111111111

Rate Schedule: E1 X Residential Service

07/02/2019 - 07/31/2019 Your Tier Usagel�-1��-2�

Tier 1 Allowance	297.00	kWh	(30 days x 9.9 kWh/day)
Tier 1 Usage	297.000000	kWh	@$0.22376	$66.46
Tier 2 Usage	83.000000	kWh	@$0.28159	23.37
Generation Credit				-44.68
Power Charge Indifference Adjustment				10.26
Franchise Fee Surcharge				0.25
Total PG&E Electric Delivery Charges				$55.66

Electric Usage This Period: 380.000000 kWh, 30 billing days
30kWh						----- =	Average Daily Usage 12.67 I
24
18
12	---------		------------�•--·--- - ------					----	--	- -
6
0	--+------"P.__.,.___.,._.,.__.,.___.,._.,.__.,.___.,._.,.__.,.__.,._.,.__.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.____.,.___,
	7/2	7/5	7/8	7/11	7/14	7/17	7/20	7/23	7/26	7/29

Due Date:	09/28/2019
Service Information	1111111111
Meter#	1111111111
Current Meter Reading	37,710
Prior Meter Reading	37,330
Total Usage	380.000000 kWh
Baseline Territory	X
Heat Source	B - Not Electric
Serial	G
Rotating Outage Block	50

Visit www.pge.com/MyEnergy for a detailed bill comparison.	Page 3 of 6

ENERGY STATEMENT

www.pge.com/MyEnergy

Details of Silicon Valley Clean Energy Electric Generation Charges

08/02/2019 - 08/31/2019 (30 billing days)

Service For: 12345 ENERGY CT

Service Agreement ID: 11111111

07/02/2019 - 07/31/2019

Rate Schedule:	E-1	$32.37
Generation - Total	380.000000 kWh @$0.08519
	Net Charges 32.37	0. 11
Energy Commission Surcharge
Customers receive clean electricity and save money with SVCE. Please see updated
SVCE electric rates and comparisons to PG&E at www.svcleanenergy.com/rates
Total Silicon Valley Clean Energy		$32.48
Electric Generation Charges

Account No:	1234567890-1
Statement Date:	09/07/2019
Due Date:	09/28/2019
Service Information
Total Usage	380.000000 kWh

For questions regarding charges on this page, please contact:

SILICON VALLEY CLEAN ENERGY 1-844-474-7823 customerservice@SVCleanEnergy.org

Additional Messages

About Silicon Valley Clean Energy (SVCE) Serving 13 Santa Clara County communities, SVCE is a locally-controlled, public agency providing residents and businesses with electricity from renewable and hydroelectric sources.

Understanding SVCE Charges

PG&E continues to provide and bill for electric delivery. SVCE replaces PG&E generation charges. Under PG&E Electric Delivery Charges, note the Generation Credit. This is what PG&E would have charged for power, and now credits back to you. The Power Charge Indifference Adjustment and Franchise Fee are factored into SVCE rates. Learn more:

https://www.svcleanenergy.orgies/your-bi11/.

SVCE is committed to protecting customer privacy.

Learn about our privacy policy at www.svcleanenergy.org/customer-confidenti ality

Visit www.pge.com/MyEnergy for a detailed bill comparison.	Page 4 of 6

ENERGY STATEMENT

www.pge.com/MyEnergy

Details of Gas Charges

08/02/2019 - 08/31/2019 (30 billing days)

Service For: 12345 ENERGY CT

Service Agreement ID: 1111111111

Rate Schedule: G1 X Residential Service

07/02/2019 - 07/31/2019	Your Tier Usagel�-1��-2�

Tier 1 Allowance	17.70 Therms (30 days x	0.59 Therms/day)

Tier 1 Usage	5.000000Therms @$ 1.28395	$6.42
Gas PPP Surcharge ($0.09047 /Therm)		0.45
Total Gas Charges		$6.87

Account No: 1234567890-1

Statement Date: 09/07/2019

Due Date: 09/28/2019

Service Information

Meter#	11111111
Current Meter Reading	2,588
Prior Meter Reading	2,583
Difference	5
Multiplier	1.031647
Total Usage	5.000000 Therms
Baseline Territory	X
Serial	G

Gas Procurement Costs ($/Therm)

07/02/2019 - 07/31/2019$0.28462

Gas Usage This Period: 5.000000 Therms, 30 billing days

Therms						= Average Daily Usage 0. 17 I
5						= Average Daily Usage 0. 17 I
5
4
3
2
7/2	7/5	7/8	7/11	7/14	7/17	7/20	7/23	7/26	7/29

Visit www.pge.com/MyEnergy for a detailed bill comparison.	Page 5 of 6

ENERGY STATEMENT	Statement Date:		09/07/2019
	Account No:	1234567890-1
www.pge.com/MyEnergy	Due Date:		09/28/2019
	Due Date:		09/28/2019

Important Messages (continued from page 1)

CARE Program. You may qualify for a monthly discount with the California Alternate Rates for Energy (CARE) Program. To find out more and apply online, visit www.pge.com/care.

Usted podría reunir los requisitos de un descuento mensual con el California Alternate Rates for Energy Program (CARE). Para obtener más información y hacer su solicitud en Internet, visite www.pge.com/espanol/care.

Electric power line safety PG&E cares about your safety. Be aware of your surroundings and keep yourself, tools, equipment and antennas at least 10 feet away from overhead power lines. If you see an electric power line fall to the ground, keep yourself and others away. Call 9-1-1.

Call 811 before you dig. A common cause of pipeline accidents is damage from digging. If you plan on doing any digging, such as planting a tree or installing a fence, please call 811 at least two working days before you dig. One free call will notify underground utilities to mark the location of underground lines, helping you to plan a safe project.

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 6 of 6

Common mistakes

Filling out a Utility Bill form may seem straightforward, but many individuals make common mistakes that can delay processing or result in incorrect billing. Understanding these pitfalls can help ensure that your utility services run smoothly.

One frequent error is incomplete information. Many people forget to fill in required fields, such as their account number or service address. Leaving out crucial details can lead to confusion and delays in service activation or billing.

Another common mistake is illegible handwriting. When forms are filled out by hand, unclear writing can create problems. Utility companies may struggle to read your information, which can result in miscommunication and errors in your account setup.

Some individuals also fail to double-check their numbers. Simple mistakes, like transposing digits in a phone number or account number, can lead to significant issues. A quick review of your entries can save time and prevent complications.

Additionally, people often overlook the importance of signatures. Not signing the form can render it invalid. Always ensure that you have signed the document before submitting it to avoid unnecessary delays.

Another mistake is not providing updated contact information. If you’ve changed your phone number or email address, it’s crucial to reflect those changes on the form. Utility companies need accurate contact details to reach you regarding your account.

Some individuals also neglect to read the instructions carefully. Each utility provider may have specific requirements or additional documentation needed. Skipping this step can lead to incomplete submissions and subsequent delays.

Finally, many people submit the form without keeping a copy for their records. Retaining a copy can be helpful for future reference and can assist in resolving any disputes that may arise regarding your account.

By being aware of these common mistakes, you can ensure that your Utility Bill form is filled out correctly, leading to a smoother process and uninterrupted service.

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