If you do not authorize Xcel Energy to share with HomeSmart from Xcel Energy the information described in the form below, HomeSmart from Xcel Energy will be unable to open an account for you.
Please review the form and complete your information where required below:
All requested information must be provided for the consent to be valid. This form may be available from your utility provider in other languages. To obtain a copy in another language, please contact Xcel Energy. Para obtener una copia de este formulario en español, por favor contacte a su proveedor de servicios públicos.
Utility Name and Contact: Public Service Company of Colorado d/b/a Xcel Energy
By signing this form, you allow your utility to give the following information to:
Organization/Trade Name: HomeSmart from Xcel Energy
This organization will receive the following customer data:
This information will be used to:
DATA COLLECTION PERIOD
You may terminate this consent at any time, including the termination of your HomeSmart from Xcel Energy account, by sending a written request with your name and service address to:
Xcel Energy, P.O. Box 8, Eau Claire, WI 54702-9988
By signing this form you acknowledge and agree that you are the customer of record for this account and that you authorize Xcel Energy to disclose your customer data as specified in this form.
*** Customer data can provide insight into activities within the premises receiving utility service. Your utility may not disclose your customer data except (1) if you authorize the disclosure, (2) to contracted agents that perform services on behalf of the utility, or (3) as otherwise permitted or required by laws or regulations.***
***You are not required to authorize the disclosure of your customer data. Not authorizing disclosure will not affect your utility services.***
***You may access your standard customer data from your utility without any additional charge.***
***Your utility will have no control over the data disclosed pursuant to this consent, and will not be responsible for monitoring or taking any steps to ensure that the data recipient maintains the confidentiality of the data or uses the data as authorized by you.***
***In addition to the [Customer Data] described above, the data recipient may also receive the following from your utility: your name; account number; service number; meter number; utility type; service address; premise number; premise description; meter read date(s); number of days in the billing period; utility invoice date; base rate bill amount; other charges including base rate and non-base rate adjustments; taxes; and invoice total amount. Your utility will not provide your Social Security Number or any financial account number to the data recipient.***
Proceeding No. 14R-0394EG
NOTE: If you submit this form and have not been contacted by HomeSmart by phone or mail within 10 business days, please call 303-722-7587 or 866-837-9762. Thank You!
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