Smart Power Usage Data Consent Form

Smart Power Usage Data Consent Form
Please review and provide your consent for the collection and use of your smart power usage data.
Full Name*
First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Address of Property Where Data Will Be Collected*
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Name of Utility Provider or Organization Collecting Data*
Type of Smart Power Device Installed (e.g., Smart Meter, Smart Plug, Energy Monitor)*
Billing and Usage MonitoringEnergy Efficiency AnalysisParticipation in Research or Pilot ProgramsSharing with Third-Party PartnersOther
Until further noticeFor a specific period (specify below)
If you selected 'For a specific period', please specify the end date
MonthDayYear
Date
Consent Statement
Signature (Please sign below to provide your consent)*
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Date of Consent*
MonthDayYear
Date
Should be Empty: