Residential Energy Supplier Change Authorization Form
Customer Information
Full Name
Phone Number
Email Address
Service Address
Utility Account Number
New Supplier Information
Supplier Name
Supplier Account Number (if known)
Previous Supplier Information
Previous Supplier Name
Authorization
I hereby authorize the above-named supplier to act as my agent in arranging for the supply of energy to my account and to manage all associated activities related to this change of energy supplier.
Customer Signature
Date
Additional Notes