Utility Customer Authorization to Release
Gas and/or Electric Usage Information to Focus on Energy
OFFICE USE ONLY
PROJECT ID:
SECTION A: This section is to be completed by the utility customer. Please print or type.
Business Name
Business Address
Contact Name
Contact Phone
City
State
Contact Email
Utility Name(s)
ZIP Code
INFORMATION TO BE RELEASED – Usage records for the following facilities may be released to Focus on Energy. Additional requests may be listed on an attachment
to this form. Data will be provided for multiple meters at a single premise provided they are on the above noted customer’s utility account(s). A multi-family premise
may require releases from individual tenants.
Premise 1
Premise Address (address at the meter location, not the billing or company address) City
Release Natural Gas Usage Data
Release Electric Usage Data
Account Number
Premise 2
Premise Address (address at the meter location, not the billing or company address) City
Release Natural Gas Usage Data
Release Electric Usage Data
Account Number
State
ZIP Code
Meter Number
State
ZIP Code
Meter Number
The undersigned utility customer requests and authorizes (utility name) _______________________________________________________________, hereafter referred to
as the utility company, to release the information listed above to the party named in Section B of this form. Focus on Energy maintains confidentiality agreements with
its contractors and subcontractors and this billing information will be kept confidential and used for Focus on Energy projects only. The utility customer also releases the
utility company from any and all liability arising from or connected with providing this information to Focus on Energy. This authorization expires two years from the signature date below and allows Focus on Energy to request data multiple times within this time period if needed to validate savings or benchmark customer energy use.
Authorized Customer Signature
Title
Date
Focus on Energy has permission to share my company’s project information and results with my utility, unless I choose to say “no” by
initialing the box at right. (Initial Box at right to indicate “Do NOT share my data.”)
SECTION B: This section is to be completed by the Focus on Energy agency or organization that is to receive the information. Please print or type.
Name
Organization
Phone
Email
Business Address
City
State
ZIP Code
INFORMATION REQUESTED – Please check the information desired and fill in the blanks as appropriate. NOTE: Contact the utility to verify the availability of interval data.
12
Months of recent metering and usage data beginning:
and ending:
12
Months of peak electric demand data beginning:
and ending:
12
Months of recent interval data beginning (see note above):
and ending:
Signature of the Focus on Energy representative to whom this information is to be released.
Date
Please forward this request to your appropriate utility contact.
BP-1189-0110
PAGE 1
Adams-Columbia Electric Cooperative
FAX: 608.339.7756
Mail: PO Box 70, 401 E. Lake Street, Friendship, WI 53934
Kiel Utilities
FAX: 920.894.2585
Mail: Kiel Utilities, Attn: Customer Billing, 621 Sixth Street,
PO Box 98, Kiel, WI 53042
Shullsburg Electric Utility
FAX: 608.965.4809
Mail: Shullsburg Electric Utility, Attn: Ron Schardt,
PO Box 580, Shullsburg, WI 53586
La Farge Municipal Utilities
FAX: 608.625.2800
Mail: LaFarge Municipal Utilities, Attn: Wayne Carpenter,
PO Box 39, LaFarge, WI 54639
Spooner Municipal Utilities
FAX: 715.635.9319
Mail: Spooner Municipal Electric, Utility Attn: Al Cusick,
PO Box 548, Spooner, WI 54801
Argyle Municipal Electric Utility
FAX: 608.543.3272
Mail: Argyle Utility, Attn: Randy Martin, PO Box 246, Argyle, WI 53504
Madison Gas and Electric Company
FAX: 608.252.4714
Mail: Madison Gas and Electric Co., Attn: Customer Center,
PO Box 1231, Madison, WI 53701-1231
St. Croix Valley Naural Gas
FAX: 715.425.1075
Mail: St. Croix Gas, Attn: Marti Piepgras,
415 S. Second Street, River Falls, WI 54022
Bangor Municipal Utility
FAX: 608.486.2800
Mail: Argyle Utility Attn: Carol Hesselberg
106 15th Avenue North, PO Box 130, Bangor, WI 54614-0130
Manitowoc Public Utilities
FAX: 920.686.4348
Mail: Manitowoc Public Utilities, Attn: Dan Salm, 1303 S. 8th Street,
PO Box 1090, Manitowoc, WI 54221-1090
Stratford Water and Electric Utility
FAX: 715.687.4435
Mail: Stratford Water & Electric Department, Attn: Jerry Frodl,
PO Box 12, Stratford, WI 54484
Barron Light & Water
FAX: 715.537.3714
Mail: PO Box 156, 1303 E. Division Avenue, Barron, WI 54812
Marshfield Utilities
FAX: 715.389.2016
Mail: PO Box 670, 2000 South Central Avenue,
Marshfield, WI 54449
Belmont Municipal Light & Water
FAX: 608.762.5525
Mail: Belmont Municipal Light & Water, Attn: Dan Vannatta,
PO Box 6, Belmont, WI 53510
Mazomanie Electric Utility
FAX: 608.965.4809
Mail: Mazomanie Electric Utility, Attn: Kia Pena, PO Box 26,
Mazomanie, WI 53560
Benton Electric & Water Utility
FAX: 608.759.3212
Mail: Benton Electric and Water Utility, Attn: John Perkins,
PO Box 53, Benton, WI 53803
Medford Electric Utility
FAX: 715.748.2339
Mail: Medford Electric Utility, Attn: Michael Frey,
639 S. Second Street, Medford, WI 54451
Vernon Electric Cooperative
FAX: 608.634.7452
Mail: 110 Saugstad Road, Westby, WI 54667
Bloomer Electric Utility
FAX: 715.568.4448
Mail: Bloomer Electric and Water, Utility, Attn: Pete Paulson,
1503 Main Street, Bloomer, WI 54724
Midwest Natural Gas Company
FAX: 608.781.1022
Mail: Midwest Natural Gas Co. Attn: James Senty,
PO Box 478, Whitehall, WI 54773
Viola Municipal Utility
FAX: 608.627.1700
Mail: Viola Municipal Electric Utility, Attn: Allen Blakley,
PO Box 38, Viola, WI 54664
Cadott Light and Water Department
FAX: 715.289.3737
Mail: Cadott Light and Water Department, Attn: Ray Weiland,
PO Box 40, Cadott, WI 54727
New Lisbon Municipal Light & Water
FAX: 608.562.3473
Mail: PO Box 218, 232 W. Pleasant Street, New Lisbon, WI 53950
We Energies
FAX: Business Center 800.354.3585
Mail: We Energies, Attn: Customer Contact Center–Business Center,
PO Box 2046, Milwaukee, WI 53201-2046
Alliant Energy
(refer to Wisconsin Power and Light in 3rd column)
Arcadia Electric and Water Plant
FAX: 608.323.3242
Mail: 203 West Main Street, Arcadia, WI 54612
Cashton Municipal Utilities
FAX: 608.654.7383
Mail: Cashton Municipal Light and Water Plant, Attn: John Hauser,
PO Box 188, Cashton, WI 54619
Centuria Municipal Electric Utility
FAX: 715.646.2666
Mail: Centuria Municipal Electric Utility, Attn: Glenn Melin,
PO Box 280, Centuria, WI 54824
City Gas Company
FAX: 715.623.2099
Mail: City Gas Co., Attn: Robert Rice, 809 Fifth Avenue Antigo, WI 54409
Clark Electric Cooperative
Fax: 715.267.7355
Mail: PO Box 190, 124 N. Main Street, Greenwood, WI 54437
Clintonville Utilities
FAX: 715.823.7650
Mail: Clintonville Utilities, Attn: Penny Kettenhoven,
50-10th Street, Clintonville, WI 54929
Cornell Municipal Electric Utility
FAX: 715.239.3714
Mail: Cornell Municipal Lighting Department, Attn: Ed Jenneman,
PO Box 796, Cornell, WI 54732
Cumberland Municipal Utility
FAX: 715.822.3621
Mail: Cumberland Municipal Utility, Attn: Charles Christensen,
PO Box 726, Cumberland, WI 54829
Eau Claire Energy Cooperative
FAX: 715-832.2055
Mail: ECEC, Attn: David Graves, PO Box 368 Fall Creek, WI 54742-0368
Elkhorn Light & Water
FAX: 262.741.5131
Mail: PO Box 920, 9 S. Broad Street, Elkhorn, WI 53121
Elroy Water & Light
FAX: 608.462.2404
Mail: City of Elroy, Attn: Carole Brown, 225 Main Street, Elroy, WI 53929
Fennimore Municipal Utility
FAX: 608.822.6007
Mail: Fennimore Municipal Utilities, Attn: Margaret Sprague,
860 Lincoln Avenue, PO Box 17, Fennimore, WI 53809
Gresham Municipal Water & Electric Plant
FAX: 715.787-1313
Mail: Gresham Municipal Water & Electric Plant, Attn: Lee Ebert,
PO Box 50, Gresham, WI 54128
BP-1189-0110
Oakdale Electric Cooperative
FAX: 608.372.5173
Mail: PO Box 128, 489 N. Oakwood Street, Oakdale, WI 54649
Oconto Electric Cooperative
FAX: 920.846.4327
Mail: PO Box 168, 7479 REA Rdoad, Oconto Falls, WI 54154
Pardeeville Public Utilities
FAX: 608.429.3714
Mail: Pardeeville Public Utilities, Attn: David Tracey,
PO Box 217, 114 Lake Street, Pardeeville, WI 53954
Pierce-Pepin Cooperative Services
FAX: 715.273.4476
Mail: PO Box 420, W7725 US Highway 10, Ellsworth, WI 54011
Polk-Burnett Electric Cooperative
FAX: 715.646.2404
Mail: 1001 State Road 35, Centuria, WI 54824-9020
Superior Water, Light & Power Company
FAX: 715.395.6300
Mail: Superior Water, Light & Power Company, Attn: Customer Call Center,
PO Box 519, Superior, WI 54880.
If you have questions, call SWLP at 715.394.2200
Trempeleau Electric Department
FAX: 608.534.6280
Mail: PO Box 247, 24455 3rd Street, Trempealeau, WI 54661
Wisconsin Power & Light Company
FAX: 608.458.0100 Attn: Customer Service Center
Mail: Alliant Energy-Wisconsin Power & Light Company, Attn: Customer
Service Center, 4902 N. Biltmore Lane, Madison, WI 53718
Wisconsin Dells Power & Light Utility
FAX: 608.254.7329
Mail: WI Dells Power & Light, Attn: Mike Horkan,
300 LaCrosse Street, Wisconsin Dells, WI 53365
Wisconsin Public Power Member Utilities
(See below for more information)
Wisconsin Public Service Corporation
FAX: 800.305.9754
E-mail: [email protected]
Mail: Wisconsin Public Service, Attn: Business Solution Center SCA2
PO BOX 19001, Green Bay WI, 54307-9001
An electronic copy of the request information will be e-mailed.
If you have questions, call WPS at 877.444.0888
Price Electric Cooperative
FAX: 715.339.2921
Mail: Price Electric Cooperative, Attn: Marilee Opresik,
PO Box 110, Phillips, WI 54555
Wisconsin Rapids Water Works & Lighting Commission
FAX: 715.423.2831
Mail: PO BOX 399, 221-16th Street S., Wisconsin Rapids, WI 54494
Princeton Light & Water Dept.
FAX: 920.295.3441
Mail: Princeton Light & Water Department, Attn: John Anderson,
438 West Main Street, Princeton, WI 54968
Wonewoc Municipal Water and Light Dept.
FAX: 608.464.7425
Mail: Wonewoc Municipal Water & Light Department, Attn: Don Hubele
PO Box 37, Wonewoc, WI 53968
Rice Lake Utilities
FAX: 715.236.7934
Mail: Rice Lake Utilities, Attn: Kristi Nelson,
320 W. Coleman Street, Rice Lake, WI 54868
Xcel Energy
FAX: 800.895.2895
Mail: Xcel Energy, Attn: Customer Contact Center,
PO Box 8, Eau Claire, WI 54702-0008
If you have questions, call Xcel Energy at 800.895.4999.
Richland Electric Cooperative
FAX: 608.647-4265
Mail: Richland Electric Cooperative, Attn: Ed Lund,
PO Box 439, 1027 N. Jefferson Street, Richland Center, WI 53581
Rock Energy Cooperative
FAX: 608.752.6620
Mail: PO Box 1758, 2815 Kennedy Road, Janesville, WI 53547
Sauk City Utilities
FAX: 608.643.2670
Mail: 726 Water Street, Sauk City, WI 53583
Scenic Rivers Energy Cooperative
FAX: 608.723.2688
Mail: Scenic Rivers Energy Cooperative, Attn: Megan Graney,
231 N. Sheridan, Lancaster, WI 53813
Please contact the following utilities to learn their requirements:
Consolidated Water Power Company
Dahlberg Light & Power Company
North Central Power Company
Northwestern Wisconsin Electric Company
Pioneer Power & Light Company
Westfield Milling & Electric Light Company
If your customer is a WPPI member utility, contact the customer’s
Energy Services Representative or visit the online link below, click on
the member utility’s Web site, and you will find the contact information: http://www.wppisys.org/member_utilities/
Revision: MG version – October 15, 2009.
Contact Martha Grasty at 608.663.3753 or [email protected] if
you have changes or comments.
Shawano Municipal Utilities
FAX: 715.524.3708
Mail: Shawano Municipal Utilities, Attn: Andy Onesti,
122 N. Sawyer, Shawano, WI 54166
PAGE 2