Pa. Code tit. 52, pt. I, subpt. C, ch. 56, subch. V, app E
Once in a while, for one reason or another, a customer fails to pay his or her <UTILITY> bill. Under the Third-Party Notification program, <UTILITY> will notify you and another person you choose to receive copies of shut-off notices. The third-party can be a trusted relative, friend, clergy member, or social service agency. The Third-Party Notification program is voluntary and can help you if you are hospitalized, away from home for extended periods of time or homebound. The third-party is not responsible for paying your bills and this program will not stop <UTILITY> from shutting off your <UTILITY> service if you do not pay your bills. When a third-party contacts <UTILITY> about the shut off notice, we will tell them what you can do to stop the shut off. The third-party does not have the right to make a payment agreement for you.
To sign up, both you and the third-party must complete and sign the form below. Do not return this with your bill, return it to:
<UTILITY NAME>
<UTILITY ADDRESS>
<CITY, STATE, POSTAL CODE>
IMPORTANT THINGS TO REMEMBER:
* Notify us immediately if you want to change or drop your third-party.
* Notify us if your third-party moves.
* Notify us if you move and you want the third-party transferred to your new address.
Please sign me up for the third-party Notification program. By completing this form and returning it to <UTILITY>, I request that a copy of any shut off notice be given to the person or agency named below.
CUSTOMER NAME:
<UTILITY> ACCOUNT/CUSTOMER NUMBER:
CUSTOMER ADDRESS:
CUSTOMER SIGNATURE:
DATE:
Receipt of a copy of a shut off notice by the third-party does not place any obligation on that party to pay the <UTILITY> bill for the customer named above nor will it necessarily stop shut off if payment is not made. The notice simply reminds the third-party of a chance to help the customer solve the problem.
THIRD-PARTY NAME:
THIRD-PARTY ADDRESS:
THIRD-PARTY SIGNATURE:
DATE:
Pa. Code tit. 52, pt. I, subpt. C, ch. 56, subch. V, app E