Printable Utility Bill Template
The Utility Bill form serves as a crucial document for managing and tracking the consumption of essential services such as electricity, water, and gas. It provides a detailed breakdown of usage, charges, and payment history, enabling individuals and businesses to monitor their utility expenses effectively. Typically, this form includes sections for account information, billing periods, and payment due dates, ensuring that users have all the necessary details at their fingertips. Additionally, it often features information on payment options, late fees, and customer service contacts, which can assist in resolving any billing disputes or inquiries. Understanding this form is vital for consumers looking to manage their utility costs, as it empowers them to make informed decisions regarding their energy consumption and payment habits.
Common mistakes
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Failing to provide accurate personal information. Ensure that your name, address, and contact details are correct. Mistakes in this area can delay processing.
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Not including the correct account number. This number is essential for identifying your utility account. Double-check it against previous bills.
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Overlooking the payment amount. Verify the total due before submitting. Incorrect amounts can lead to late fees or service interruptions.
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Ignoring submission deadlines. Each utility company has specific due dates. Missing these can result in penalties or service disconnection.
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Neglecting to sign the form. A signature is often required to validate your submission. Without it, the form may be considered incomplete.
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Key takeaways
When filling out and using the Utility Bill form, keep these key takeaways in mind:
- Accuracy is crucial. Double-check all information entered to avoid delays or issues with your utility service.
- Provide complete details. Ensure that you include all required fields, such as your account number, address, and contact information.
- Understand your responsibilities. Familiarize yourself with the terms and conditions associated with your utility services.
- Keep a copy for your records. Always save a copy of the completed form for your personal records and future reference.
- Submit on time. Make sure to send in the form by the deadline to avoid any interruptions in service.
By following these guidelines, you can navigate the Utility Bill form process smoothly and ensure that your utility services remain uninterrupted.
Utility Bill Example
ENERGY STATEMENT |
Account No: |
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Statement Date: |
09/07/2019 |
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www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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Service For:
SPARKY JOULE 12345 ENERG'( CT
Questions about your bill?
Ways To Pay
www.pge.com/waystopay
Your Account Summary
Amount Due on Previous Statement |
$91.57 |
Payment(s) Received Since Last Statement |
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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 |
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Daily Usage Comparison |
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$200 |
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1 Year |
Last |
Current |
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Ago |
Period |
Period |
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$150 |
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12.50 |
12.16 |
12.67 |
$100 |
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■ ■ ■ |
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$50 |
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Electric kWh / Day |
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$0 |
0.12 |
0.16 |
0.17 |
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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 |
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■ |
Electric |
D |
Gas |
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Gas Therms/ Day |
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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
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
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: |
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09/28/2019 |
$88.14 |
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$ |
PG&E
BOX 997300
SACRAMENTO, CA
Page 1 of 6
ENERGY STATEMENT |
Account No: |
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Statement Date: |
09/07/2019 |
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www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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Important Phone Numbers -
TTY
Servicio al Cliente en Espanol (Spanish)
Djch VI) khach tieng Vi�t (Vietnamese) |
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Business Customer Service |
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
If you believe there is an error on your bill, please call
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
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
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
Gas Public Purpose Program (PPP) Surcharge. Used to fund
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 |
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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 |
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PCIA |
10.26 |
Taxes and Other |
0.25 |
Total Electric Charges |
$55.66 |
"PG&E" refers to Pacific Gas and Electric Company, a subsidiary of PG&E Corporation. © 2019 Pacific Gas and Electric Company. All rights reserved. Please do not mark in box. For system use only.
Update My Information (English Only)
Please allow
Account Number:
Change my mailing address to: ________________
City _____________ State |
ZIP code ____ |
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Primary |
Primary |
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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
•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
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
Tier 1 Allowance |
297.00 |
kWh |
(30 days x 9.9 kWh/day) |
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Tier 1 Usage |
297.000000 |
kWh |
@$0.22376 |
$66.46 |
Tier 2 Usage |
83.000000 |
kWh |
@$0.28159 |
23.37 |
Generation Credit |
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Power Charge Indifference Adjustment |
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10.26 |
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Franchise Fee Surcharge |
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0.25 |
Total PG&E Electric Delivery Charges |
$55.66 |
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Electric Usage This Period: 380.000000 kWh, 30 billing days |
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30kWh |
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Average Daily Usage 12.67 I |
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24 |
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18 |
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- - |
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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# |
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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 |
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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: |
$32.37 |
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Generation - Total |
380.000000 kWh @$0.08519 |
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Net Charges 32.37 |
0. 11 |
Energy Commission Surcharge |
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Customers receive clean electricity and save money with SVCE. Please see updated |
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SVCE electric rates and comparisons to PG&E at www.svcleanenergy.com/rates |
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Total Silicon Valley Clean Energy |
$32.48 |
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Electric Generation Charges |
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Account No: |
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Statement Date: |
09/07/2019 |
Due Date: |
09/28/2019 |
Service Information |
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Total Usage |
380.000000 kWh |
For questions regarding charges on this page, please contact:
SILICON VALLEY CLEAN ENERGY
Additional Messages
About Silicon Valley Clean Energy (SVCE) Serving 13 Santa Clara County communities, SVCE is a
Understanding SVCE Charges
PG&E continues to provide and bill for electric delivery. SVCE replaces PG&E generation charges. Under PG&E Electric Delivery Charges, note the Generation Credit. This is what PG&E would have charged for power, and now credits back to you. The Power Charge Indifference Adjustment and Franchise Fee are factored into SVCE rates. Learn more:
SVCE is committed to protecting customer privacy.
Learn about our privacy policy at
Visit www.pge.com/MyEnergy for a detailed bill comparison. |
Page 4 of 6 |
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ENERGY STATEMENT
www.pge.com/MyEnergy
Details of Gas Charges
08/02/2019 - 08/31/2019 (30 billing days)
Service For: 12345 ENERGY CT
Service Agreement ID: 1111111111
Rate Schedule: G1 X Residential Service
07/02/2019 - 07/31/2019 |
Your Tier |
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Tier 1 Allowance |
17.70 Therms (30 days x |
0.59 Therms/day) |
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Tier 1 Usage |
5.000000Therms @$ 1.28395 |
$6.42 |
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Gas PPP Surcharge ($0.09047 /Therm) |
0.45 |
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Total Gas Charges |
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$6.87 |
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Account No:
Statement Date: 09/07/2019
Due Date: 09/28/2019
Service Information
Meter# |
11111111 |
Current Meter Reading |
2,588 |
Prior Meter Reading |
2,583 |
Difference |
5 |
Multiplier |
1.031647 |
Total Usage |
5.000000 Therms |
Baseline Territory |
X |
Serial |
G |
Gas Procurement Costs ($/Therm)
07/02/2019 - 07/31/2019$0.28462
Gas Usage This Period: 5.000000 Therms, 30 billing days
Therms |
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= Average Daily Usage 0. 17 I |
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7/2 |
7/5 |
7/8 |
7/11 |
7/14 |
7/17 |
7/20 |
7/23 |
7/26 |
7/29 |
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Visit www.pge.com/MyEnergy for a detailed bill comparison. |
Page 5 of 6 |
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ENERGY STATEMENT |
Statement Date: |
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09/07/2019 |
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Account No: |
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www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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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
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
Understanding Utility Bill
What is the Utility Bill form?
The Utility Bill form is a document used to verify the payment of utility services, such as electricity, water, gas, or internet. It serves as proof of residence and can be required for various purposes, including applying for loans, government assistance, or renting an apartment.
Who needs to fill out the Utility Bill form?
Typically, individuals who are applying for housing, financial aid, or any service that requires proof of residency will need to fill out this form. It may also be necessary for businesses that require utility verification for licensing or compliance purposes.
What information is required on the Utility Bill form?
The form usually requires the following information:
- Your name and address
- The utility provider's name and contact information
- Account number
- Billing period
- Total amount due or paid
- Payment date
Make sure to provide accurate and up-to-date information to avoid any delays in processing.
How do I obtain a copy of my utility bill?
You can typically obtain a copy of your utility bill through the following methods:
- Visit your utility provider’s website and log into your account.
- Contact customer service via phone or email and request a copy.
- Check your email if you receive electronic statements.
- Visit a local office of your utility provider, if available.
Be prepared to provide your account information for verification purposes.
Can I use a utility bill from someone else?
In most cases, you cannot use a utility bill from someone else unless you have their permission and can provide additional documentation. This is especially true if the bill is being used to verify your residency. Always check the specific requirements for the situation you are facing.
What if my utility bill is in a different name?
If your utility bill is in a different name, you may need to provide additional documentation to prove your residency. This could include a lease agreement, a government-issued ID with your current address, or a notarized letter from the bill holder. Each situation is unique, so it’s best to confirm with the requesting entity what they will accept.
How often do I need to submit a Utility Bill form?
The frequency of submission depends on the requirements of the organization or agency requesting the form. Some may ask for a recent utility bill every time you apply for a service, while others may only need it once a year or when your circumstances change.
Is there a deadline for submitting the Utility Bill form?
Deadlines for submitting the Utility Bill form vary by organization. It’s important to check with the specific entity for their timelines. Failing to meet a deadline may result in delays or denial of your application, so be proactive in gathering and submitting your documents.
How to Use Utility Bill
Filling out the Utility Bill form is a straightforward process. This form will help ensure that your utility services are properly set up and billed to the correct address. Follow the steps below to complete the form accurately.
- Begin by entering your full name in the designated field.
- Provide your current address, including street, city, state, and zip code.
- Next, fill in your contact information, including your phone number and email address.
- Indicate the type of utility service you are applying for, such as water, electricity, or gas.
- Enter your account number if you have one; if not, leave this field blank.
- Specify the date you would like the service to begin.
- Review all the information you have entered to ensure accuracy.
- Sign and date the form at the bottom to confirm your application.