Fillable CONSENT TO DISCLOSE UTILITY CUSTOMER DATA (CenterPoint Energy)

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CONSENT TO DISCLOSE UTILITY CUSTOMER DATA (CenterPoint Energy)

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FaxEmail
Utility Name and Contact
Physical and Mailing Address
Phone
612-321-4806custserv@centerpointenergy.com
CenterPoint Energy
505 Nicollet Avenue, P.O. Box 59038, Minneapolis, Minnesota 55459-0038
612-372-4727
For additional information, including the utility's privacy policy, visit www.CenterPointEnergy.com
By signing this form, you allow your utility to give the following information to:
Organization/Trade Name
Physical and Mailing Address
Contact Name (if available)
FaxEmailPhone
This organization will receive the following customer data:
Other (specify)
Information from your meter collected by your utility service provider from natural gas service
Information regarding your participation in renewable energy, demand-side management, load management,
energy efficiency or other utility programs
This information will be used to:
Other (specify)
Provide you with products or services you requested
Offer you products or services that may be of interest to you
Determine your eligibility for an energy program
Analyze your energy usage
DATA COLLECTION PERIOD
The relevant timeframe associated with the requested data is from and will
You may terminate this consent at any time by sending a written request with your name and service address
to your utility.
end on
be effective until terminated by you.
CONSENT TO DISCLOSE UTILITY CUSTOMER DATA
CNP 1366 (7-2017)
Page 1 of 2
All requested information must be provided for the consent to be valid. This form may be available from your utility
provider in other languages. To obtain a copy in another language, please contact your utility provider.
TO BE COMPLETED BY THE DATA RECIPIENT
CUSTOMER DISCLOSURES
*** Customer data can provide insight into activities within the premises receiving utility service. Your utility may not
disclose your customer data except (1) if you authorize the disclosure, (2) to contracted agents that perform services on
behalf of the utility, or (3) as otherwise permitted or required by laws or regulations.***
*** You are not required to authorize the disclosure of your customer data. Not authorizing disclosure will not affect your
utility services.***
*** You may access your standard customer data from your utility without any additional charge.***
*** Your utility will have no control over the data disclosed pursuant to this consent, and will not be responsible for
monitoring or taking any steps to ensure that the data recipient maintains the confidentiality of the data or uses the data
as authorized by you. Please be advised that you may not be able to control the use or misuse of your data once it has
been released.****
*** In addition to the [Customer Data] described above, the data recipient may also receive the following from your utility;
your name; account number; service number; meter number; utility type; service address; premise number; premise
description; meter read date(s); number of days in the billing period; utility invoice date; base rate bill amount; other
charges including base rate and non-base rate adjustments; taxes; and invoice total amount. Your utility will not provide
any other information, including Personally Identifiable Information such as your Social Security Number or any financial
account number to the data recipient thought this consent form.***
TO BE COMPLETED BY THE CUSTOMER
PLEASE READ THE ABOVE CUSTOMER
DISCLOSURES BEFORE SIGNING THIS FORM
By signing this form you acknowledge and agree that you are the customer of record for this account and that you
authorize your utility service provider to disclose your customer data as specified in this form.
Page 2 of 2
CNP 1366 (7-2017)
CUSTOMER ACCOUNT NUMBER
SIGNATURE OF CUSTOMER OF RECORD
PRINTED NAME
SERVICE ADDRESS
DATE SIGNED
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CONSENT TO DISCLOSE UTILITY CUSTOMER DATA (CenterPoint Energy)

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Completed 22 July 2021

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