Get Electric Sample Form No. 62-3481 Medical Baseline Allowance ...

This guide provides step-by-step instructions on how to fill out the Electric Sample Form No. 62-3481 for the Medical Baseline Allowance online, ensuring all necessary information is accurately captured for successful enrollment or re-certification.

Follow the steps to fill out the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your account and customer information in Step 1. This includes entering your PG&E customer account number, your name as it appears on the bill, the medical baseline resident's name (if different), the service address, and your mailing address (if applicable). You should also include your home and work phone numbers.
3. In Step 2, fill out the details for customers billed by another company. Provide the name and address of the mobile home or apartment complex, the complex manager's name, and their contact number, alongside the tenant's name and phone number.
4. Step 3 requires you to indicate how you prefer to be contacted in case of a planned or unplanned outage. Choose your preferred methods (up to two) and provide the necessary information next to each selection, such as phone numbers and email addresses.
5. In Step 4, you will need to sign the form certifying that the information provided is accurate, the medical baseline resident lives at the given address, and consent is provided for PG&E to verify the details. Enter the date of your signature.
6. Finally, if you are a licensed medical doctor completing Step 5, certify the medical needs of your patient, including the necessity of any life-support devices and additional heating or cooling. Fill out your name, contact details, and medical license number before signing and dating the section.
7. After completing the form, ensure all information is correct and proceed to save your changes. You may download, print, or share the form as needed.

Ensure you complete the Electric Sample Form No. 62-3481 online today for your medical baseline allowance.