Utility Bill Template
Statement Date
-
Month
-
Day
Year
Date
Statement Start Date
-
Month
-
Day
Year
Date
Statement End Date
-
Month
-
Day
Year
Date
Account No.
Account Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Meter Information
Date
Usage (kWh)
Cost (per kWh)
Amount ($)
1
Bill Summary
Previous Charges ($)
Current Charges ($)
Tax ($)
Total Amount ($)
Due Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: