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APARTMENT OWNER PROGRAM AUTHORIZATION FOR ELECTRIC SERVICE US1- (R12-9-04) DATE: TO: CITY OF ANAHEIM PUBLIC UTILITIES DEPARTMENT I am the legal owner of the addresses listed below and I hereby authorize the City of Anaheim Public Utilities Department to act in my behalf in establishing electric service to the following address(es). (Use the reverse side if additional space is necessary.) I further acknowledge all responsibility for the billings on each listed address for those periods when an occupant has not applied for service, or until service is discontinued, or until I submit written notice withdrawing this authorization. Name Phone DBA By Title (signature) Individuals authorized to handle utility requests on my behalf: Name Phone Mail bills to: Form of Business Organization Sole Proprietorship Corporation Limited Partnership Co-Partnership Partners or Corporation Officers Name Title Phone