Get Written Consent To Release Confidential Customer ... - Dominion

This guide provides clear, step-by-step instructions on how to fill out the Written Consent to Release Confidential Customer Information form for Dominion Virginia Power and Dominion North Carolina Power. Follow these guidelines to ensure your information is accurately submitted.

Follow the steps to complete the form effectively.

1. Click 'Get Form' button to obtain the form and open it in your preferred document editor.
2. Begin by completing Section A, where you will provide your written consent for Dominion to release your Usage-Related Information to a designated third party. Fill in the Authorized Party’s name, address, telephone number, fax number, and email address, ensuring all details are accurate.
3. Next, list the Dominion account numbers that are included in this authorization along with the name on the account for each. Make sure to input all relevant account details as specified in the form.
4. If you wish to authorize the same third party to take specific actions on your account, complete Section B by checking the appropriate actions you want them to perform. Initial next to each action to confirm your consent.
5. In Section C, indicate how long you want the authorization to remain valid. You can choose a specific date or a duration of one, two, or three years as per your requirement. Initial next to your selected option.
6. Finally, review your entries for accuracy and completeness. Sign and date in Section D, ensuring you understand the terms and acknowledge your authority to give consent. Don’t forget to initial at the bottom of each page where indicated.
7. Once the form is completed, you can either email it to Customer_ServiceCC@ccdompower.com or mail it to the Customer Care and Energy Management Department at the specified address.

Take the first step towards managing your account - complete your Written Consent form online today.