RES 96016 - Laserfiche WebLink

Check one: rn I request that PG&E bill me directly for its services at my current billing address(es). PG&E may provide CTA with an information-only statement of my PG&E charges. rl I request that PG&E send my PG&E bill to CTA for payment, subject to approval by PG&E. If PG&E approves the CTA for this billing option, I will receive an information-only statement of my PG&E charges, sent by PG&E to my current billing address(es). PG&E must receive one completed and signed odginal of Authorization. Facsimiles or photocopies must be accompanied by an original. COMMUNICATIONS PG&E will use the following addresses to send formal notices. tadffs. PG&E service information and executed agreements to Parties. This will not change the current billing address on PG&E accounts. To Customer:. To CTA: ToPG&~ Assodation of Bay Area Gov'ts Pacific Gas & Electric Company (Customer Company Name) (CTA Company Name) Mailing Address: Mailing Address: Mailing Address: 3201 Danville BIrd Suite 275 P.O. Box 770000 Alamo CA 94507 Mail Code H28H San Frandsco CA 94177 Service Address: Service Address: Service Address: 3201 Danville Blvd Suite 275 123 Mission Street Alamo CA 94507 Mail Code H28H San Frandsco CA 94105 Attention: Attention: Attention: ABAG Coordinator Core Transport Program Adrnin. Telephone Number. Telephone Number. Telephone Number. ( ) (510 I 743-7877 (415)973-3059 Telecopy Number. Telecopy Number. Telecopy Number:. ( ) ( 510 I 743-1014 (415)973-2384 (Please Type or Print Clearly) ~t Signed by: Accepted ,bltr~.;ofZ~~u~/ho~ ~; (Signature of duly authorized representative) (~igna ed ire) For.. For. AI;odation of Bay Area Governments (Customer Company Name) (CTA Company Name) Eu_aene Y. Leon_a (Pdnt Name) (Print Name) Executive Diredor (Title) ('title) (Date) (Date) Form No. 79-845-Attachrnent A Fhicing & Regulatory Support August 18, 1995 Page 2