Free Utility Bill Template
The Utility Bill form serves as a vital document for individuals and businesses alike, playing a crucial role in managing and tracking utility expenses. This form typically includes essential information such as the account holder's name, service address, and billing period, which helps to ensure accurate record-keeping. Additionally, it outlines the specific utilities being billed, such as electricity, water, gas, or internet services, along with their respective charges. Understanding the breakdown of these charges can empower consumers to make informed decisions about their utility usage and budget accordingly. Payment options are also detailed within the form, providing clarity on due dates and acceptable methods of payment. By familiarizing oneself with the components of the Utility Bill form, users can better navigate their financial obligations and maintain good standing with service providers.
Document Specifics
| Fact Name | Description |
|---|---|
| Purpose | The Utility Bill form is used to document and verify utility expenses for various purposes, such as applying for government assistance or proving residency. |
| Common Utilities | This form typically covers electricity, water, gas, and other essential services provided to a residence. |
| Required Information | Users must provide their name, address, account number, and the billing period for accurate processing. |
| State-Specific Forms | Some states have unique requirements. For example, California's Public Utilities Code governs the documentation of utility bills. |
| Submission Process | The completed form can often be submitted online, via mail, or in person, depending on the requesting agency's guidelines. |
| Importance for Residency | Utility bills serve as proof of residency, which is crucial for various applications, including voter registration and school enrollment. |
| Retention Period | It is advisable to keep copies of utility bills for at least one year, as they may be required for audits or future applications. |
Similar forms
Water Bill: Similar to a utility bill, a water bill outlines the charges for water usage. It provides details on consumption, billing periods, and payment options.
Gas Bill: A gas bill serves the same purpose as a utility bill, detailing charges for natural gas usage. It often includes information on usage patterns and rates.
Electricity Bill: Like a utility bill, an electricity bill specifies the amount charged for electrical consumption. It typically breaks down usage by kilowatt-hours and may show historical usage data.
- Motor Vehicle Bill of Sale: To ensure accurate documentation when transferring vehicle ownership, utilize the comprehensive Motor Vehicle Bill of Sale form resources for a smooth transaction process.
Internet Bill: An internet bill is similar in that it lists charges for internet services. It includes details on the plan, usage limits, and any additional fees.
Phone Bill: A phone bill outlines charges for telephone services, including usage, plans, and any additional features. It serves as a record of communication costs.
Trash Collection Bill: This document details charges for waste disposal services. It is similar to a utility bill in that it informs residents about service fees and schedules.
Homeowner Association (HOA) Dues Statement: An HOA dues statement lists fees for community services and maintenance. It functions similarly to a utility bill by providing a breakdown of charges for community-related services.
Utility Bill Example
ENERGY STATEMENT |
Account No: |
|
Statement Date: |
09/07/2019 |
|
www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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Service For:
SPARKY JOULE 12345 ENERG'( CT
Questions about your bill?
Ways To Pay
www.pge.com/waystopay
Your Account Summary
Amount Due on Previous Statement |
$91.57 |
Payment(s) Received Since Last Statement |
|
Previous Unpaid Balance |
$0.00 |
Current PG&E Electric Delivery Charges |
$55.66 |
Silicon Valley Clean Energy Electric Generation Charges |
$32.48 |
I Total Amount Due by 08/28/2019 |
$88.14 |
Monthly Billing History |
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Daily Usage Comparison |
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$200 |
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1 Year |
Last |
Current |
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Ago |
Period |
Period |
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$150 |
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12.50 |
12.16 |
12.67 |
$100 |
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■ ■ ■ |
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$50 |
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Electric kWh / Day |
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$0 |
0.12 |
0.16 |
0.17 |
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2018 8/07 |
9/06 10/04 11/06 12/06 1/08 2/06 |
3/07 4/08 |
5/09 6/06 |
7/10 8/07 |
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■ |
Electric |
D |
Gas |
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Gas Therms/ Day |
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Visit www.pge.com/MyEnergy for a detailed bill comparison
Important Messages
The Family Electric Rate Assistance (FERA) Program provides a monthly discount on electric bills for
El Programa FERA ofrece ahorros mensuales solo en las facturas de electricidad a hogares de ingresos econ6micos bajos y medianos con tres o mas personas. Para determinar si califica, por favor llame al
Continued on page 6
Please return this portion with your payment. No staples or paper clips. Do not fold. Thank you.
®
Account Number: |
Due Date: |
Total Amount Due: |
Amount Enclosed: |
|
09/28/2019 |
$88.14 |
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$ |
PG&E
BOX 997300
SACRAMENTO, CA
Page 1 of 6
ENERGY STATEMENT |
Account No: |
|
Statement Date: |
09/07/2019 |
|
www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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Important Phone Numbers -
TTY
Servicio al Cliente en Espanol (Spanish)
Djch VI) khach tieng Vi�t (Vietnamese) |
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Business Customer Service |
Rules and rates
You may be eligible for a lower rate. To learn more about optional rates or view a complete list of rules and rates, visit www.pge.com or call
If you believe there is an error on your bill, please call
To avoid having service turned off while you wait for the outcome of a complaint to the CPUC specifically regarding the accuracy of your bill, please contact CAB for assistance. If your case meets the eligibility criteria, CAB will provide you with instructions on how to mail a check or money order to be impounded pending resolution of your case. You must continue to pay your current charges while your complaint is under review to keep your service turned on.
If you are not able to pay your bill, call PG&E to discuss how we can help. You may qualify for reduced rates under PG&E's CARE program or other special programs and agencies may be available to assist you. You may qualify for PG&E's Energy Savings Assistance Program which is an energy efficiency program for
Important definitions
Rotating outage blocks are subject to change without advance notice due to operational conditions.
Tier 1/Baseline allowance: Some residential rates are given a Tier 1/Baseline allowance - a CPUC approved percentage of average customer usage during summer and winter months. Your Tier 1/Baseline allowance provides for basic needs at an affordable price and encourages conservation. Your allowance is assigned based on the climate where you live, the season and your heat source. As you use more energy, you pay more for usage. Any usage over your baseline allowance will be charged at a higher price.
High Usage: An increased price per kWh whenever electricity usage exceeds four times the Baseline Allowance (Tier 1) in a billing period. This charge does not apply to
DWR bond charge: Recovers the cost of bonds issued by the Department of Water Resources (DWR) to purchase power to serve electric customers during the California energy crisis. DWR bond charges are collected on behalf of DWR and do not belong to PG&E.
Power Charge Indifference Adjustment (PCIA): Ensures that
Gas Public Purpose Program (PPP) Surcharge. Used to fund
Visit www.pge.com/billexplanation for more definitions. To view most recent bill inserts including legal or mandated notices, visit www.pge.com/billinserts.
Your Electric Charges Breakdown
Conservation Incentive |
|
Transmission |
12.42 |
Distribution |
35.08 |
Electric Public Purpose Programs |
4.71 |
Nuclear Decommissioning |
0.33 |
DWR Bond Charge |
1.91 |
Competition Transition Charges (CTC) |
0.42 |
Energy Cost Recovery Amount |
|
PCIA |
10.26 |
Taxes and Other |
0.25 |
Total Electric Charges |
$55.66 |
"PG&E" refers to Pacific Gas and Electric Company, a subsidiary of PG&E Corporation. © 2019 Pacific Gas and Electric Company. All rights reserved. Please do not mark in box. For system use only.
Update My Information (English Only)
Please allow
Account Number:
Change my mailing address to: ________________
City _____________ State |
ZIP code ____ |
|
Primary |
Primary |
|
Ways To Pay
•Online via web or mobile at www.pge.com/waystopay
•By mail: Send your payment along with this payment stub in the envelope provided.
•By debit card, Visa, MasterCard, American Express, or Discover: Call
•At a PG&E payment center or local office: To find a payment center or local office near you, please visit www.pge.com or call
Page 2 of 6
ENERGY STATEMENT
Details of PG&E Electric Delivery Charges
Service For: 12345 ENERGY CT
Service Agreement ID: 111111111
Rate Schedule: E1 X Residential Service
07/02/2019 - 07/31/2019 Your Tier
Tier 1 Allowance |
297.00 |
kWh |
(30 days x 9.9 kWh/day) |
|
Tier 1 Usage |
297.000000 |
kWh |
@$0.22376 |
$66.46 |
Tier 2 Usage |
83.000000 |
kWh |
@$0.28159 |
23.37 |
Generation Credit |
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Power Charge Indifference Adjustment |
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10.26 |
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Franchise Fee Surcharge |
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0.25 |
Total PG&E Electric Delivery Charges |
$55.66 |
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Electric Usage This Period: 380.000000 kWh, 30 billing days |
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30kWh |
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Average Daily Usage 12.67 I |
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24 |
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18 |
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12 |
- - |
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6 |
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0 |
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7/2 |
7/5 |
7/8 |
7/11 |
7/14 |
7/17 |
7/20 |
7/23 |
7/26 |
7/29 |
Due Date: |
09/28/2019 |
Service Information |
1111111111 |
Meter# |
|
Current Meter Reading |
37,710 |
Prior Meter Reading |
37,330 |
Total Usage |
380.000000 kWh |
Baseline Territory |
X |
Heat Source |
B - Not Electric |
Serial |
G |
Rotating Outage Block |
50 |
Visit www.pge.com/MyEnergy for a detailed bill comparison. |
Page 3 of 6 |
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ENERGY STATEMENT
www.pge.com/MyEnergy
Details of Silicon Valley Clean Energy Electric Generation Charges
08/02/2019 - 08/31/2019 (30 billing days)
Service For: 12345 ENERGY CT
Service Agreement ID: 11111111
07/02/2019 - 07/31/2019
Rate Schedule: |
$32.37 |
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Generation - Total |
380.000000 kWh @$0.08519 |
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Net Charges 32.37 |
0. 11 |
Energy Commission Surcharge |
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Customers receive clean electricity and save money with SVCE. Please see updated |
||
SVCE electric rates and comparisons to PG&E at www.svcleanenergy.com/rates |
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Total Silicon Valley Clean Energy |
$32.48 |
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Electric Generation Charges |
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Account No: |
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Statement Date: |
09/07/2019 |
Due Date: |
09/28/2019 |
Service Information |
|
Total Usage |
380.000000 kWh |
For questions regarding charges on this page, please contact:
SILICON VALLEY CLEAN ENERGY
Additional Messages
About Silicon Valley Clean Energy (SVCE) Serving 13 Santa Clara County communities, SVCE is a
Understanding SVCE Charges
PG&E continues to provide and bill for electric delivery. SVCE replaces PG&E generation charges. Under PG&E Electric Delivery Charges, note the Generation Credit. This is what PG&E would have charged for power, and now credits back to you. The Power Charge Indifference Adjustment and Franchise Fee are factored into SVCE rates. Learn more:
SVCE is committed to protecting customer privacy.
Learn about our privacy policy at
Visit www.pge.com/MyEnergy for a detailed bill comparison. |
Page 4 of 6 |
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ENERGY STATEMENT
www.pge.com/MyEnergy
Details of Gas Charges
08/02/2019 - 08/31/2019 (30 billing days)
Service For: 12345 ENERGY CT
Service Agreement ID: 1111111111
Rate Schedule: G1 X Residential Service
07/02/2019 - 07/31/2019 |
Your Tier |
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Tier 1 Allowance |
17.70 Therms (30 days x |
0.59 Therms/day) |
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Tier 1 Usage |
5.000000Therms @$ 1.28395 |
$6.42 |
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Gas PPP Surcharge ($0.09047 /Therm) |
0.45 |
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Total Gas Charges |
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$6.87 |
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Account No:
Statement Date: 09/07/2019
Due Date: 09/28/2019
Service Information
Meter# |
11111111 |
Current Meter Reading |
2,588 |
Prior Meter Reading |
2,583 |
Difference |
5 |
Multiplier |
1.031647 |
Total Usage |
5.000000 Therms |
Baseline Territory |
X |
Serial |
G |
Gas Procurement Costs ($/Therm)
07/02/2019 - 07/31/2019$0.28462
Gas Usage This Period: 5.000000 Therms, 30 billing days
Therms |
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= Average Daily Usage 0. 17 I |
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7/2 |
7/5 |
7/8 |
7/11 |
7/14 |
7/17 |
7/20 |
7/23 |
7/26 |
7/29 |
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Visit www.pge.com/MyEnergy for a detailed bill comparison. |
Page 5 of 6 |
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ENERGY STATEMENT |
Statement Date: |
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09/07/2019 |
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Account No: |
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www.pge.com/MyEnergy |
Due Date: |
09/28/2019 |
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Important Messages (continued from page 1)
CARE Program. You may qualify for a monthly discount with the California Alternate Rates for Energy (CARE) Program. To find out more and apply online, visit www.pge.com/care.
Usted podría reunir los requisitos de un descuento mensual con el California Alternate Rates for Energy Program (CARE). Para obtener más información y hacer su solicitud en Internet, visite www.pge.com/espanol/care.
Electric power line safety PG&E cares about your safety. Be aware of your surroundings and keep yourself, tools, equipment and antennas at least 10 feet away from overhead power lines. If you see an electric power line fall to the ground, keep yourself and others away. Call
Call 811 before you dig. A common cause of pipeline accidents is damage from digging. If you plan on doing any digging, such as planting a tree or installing a fence, please call 811 at least two working days before you dig. One free call will notify underground utilities to mark the location of underground lines, helping you to plan a safe project.
Visit www.pge.com/MyEnergy for a detailed bill comparison.
Page 6 of 6
Understanding Utility Bill
What is the Utility Bill form used for?
The Utility Bill form is primarily used to document and verify utility expenses. This form may be required for various purposes, such as applying for financial assistance, proving residency, or verifying income for loan applications. By providing accurate information about utility costs, individuals can ensure that their applications are processed smoothly and efficiently.
Who needs to fill out the Utility Bill form?
Anyone who needs to provide proof of their utility expenses may be required to fill out this form. This could include tenants applying for housing assistance, individuals seeking loans, or anyone needing to confirm their residency. It is important for the person completing the form to have access to their utility bills and relevant account information to ensure all details are accurate.
What information is typically required on the Utility Bill form?
The Utility Bill form generally requires information such as the name of the utility provider, account number, billing address, and the amount due. Additionally, it may ask for the date of the bill and the period it covers. Having the most recent bill on hand will help ensure that all necessary details are included and accurate.
How can I submit the Utility Bill form once completed?
After completing the Utility Bill form, submission methods can vary depending on the requirements of the organization requesting it. Common submission methods include mailing a physical copy, emailing a scanned version, or submitting it through an online portal. It is advisable to check the specific instructions provided by the requesting entity to ensure proper submission.
Dos and Don'ts
When filling out a Utility Bill form, it's important to follow certain guidelines to ensure accuracy and efficiency. Here’s a list of things you should and shouldn’t do:
- Do double-check your account number for accuracy.
- Do provide your current address clearly and completely.
- Do include all required personal information, such as your name and contact number.
- Do review the form for any errors before submission.
- Don’t leave any mandatory fields blank.
- Don’t use abbreviations that might confuse the reader.
- Don’t forget to sign and date the form if required.
By following these guidelines, you can help ensure that your Utility Bill form is processed smoothly and without unnecessary delays.
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