"Utility Service Provider Contact Information Form" - New York

Utility Service Provider Contact Information Form is a legal document that was released by the New York State Department of Public Service - a government authority operating within New York.

Form Details:

  • Released on December 28, 2007;
  • The latest edition currently provided by the New York State Department of Public Service;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Department of Public Service.

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Download "Utility Service Provider Contact Information Form" - New York

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New York State Public Service Commission
Office of Consumer Services
Service Provider Contact Information
Completed forms should be submitted by fax to 518-472-8501
Date _________
Company Name ______________________________________________________________
C Elec
C ESCO
C Cable TV
C
Service Type (Check all that apply): Gas
C ILEC
C CLEC
C Toll Only
C Other ________________________
Water
President
_____________________________________________________
Mailing Address
_____________________________________________________
_____________________________________________________
Email Address
_____________________________________________________
Phone Number
_____________________ Fax Number _____________________
Vice President / Director of Customer Service _______________________________
Mailing Address
______________________________________________________
______________________________________________________
Email Address
______________________________________________________
Phone Number
______________________ Fax Number _____________________
Primary Regulatory Complaint Manager_____________ _______________________
Mailing Address
______________________________________________________
______________________________________________________
Email Address
______________________________________________________
Phone Number
______________________ Fax Number _____________________
Secondary Regulatory Complaint Manager ________________________________________
Mailing Address
___________________________________________________________
___________________________________________________________
Email Address
___________________________________________________________
Phone Number
________________________ Fax Number ________________________
The PSC electronically transmits consumer complaints to service providers. You must
identify a fax number and/or an email address box that is shared by a group of people.
(NOTE: WE WILL NOT SEND COMPLAINTS TO PERSONAL EMAIL ADDRESSES. A
SHARED EMAIL ADDRESS MUST BE IDENTIFIED OR THE TRANSMISSION WILL
DEFAULT TO THE FAX NUMBER) Please identify the address/es to which we should
transmit our complaints:
Email: _________________________________ Fax:________________________________
Effective December 28, 2007
New York State Public Service Commission
Office of Consumer Services
Service Provider Contact Information
Completed forms should be submitted by fax to 518-472-8501
Date _________
Company Name ______________________________________________________________
C Elec
C ESCO
C Cable TV
C
Service Type (Check all that apply): Gas
C ILEC
C CLEC
C Toll Only
C Other ________________________
Water
President
_____________________________________________________
Mailing Address
_____________________________________________________
_____________________________________________________
Email Address
_____________________________________________________
Phone Number
_____________________ Fax Number _____________________
Vice President / Director of Customer Service _______________________________
Mailing Address
______________________________________________________
______________________________________________________
Email Address
______________________________________________________
Phone Number
______________________ Fax Number _____________________
Primary Regulatory Complaint Manager_____________ _______________________
Mailing Address
______________________________________________________
______________________________________________________
Email Address
______________________________________________________
Phone Number
______________________ Fax Number _____________________
Secondary Regulatory Complaint Manager ________________________________________
Mailing Address
___________________________________________________________
___________________________________________________________
Email Address
___________________________________________________________
Phone Number
________________________ Fax Number ________________________
The PSC electronically transmits consumer complaints to service providers. You must
identify a fax number and/or an email address box that is shared by a group of people.
(NOTE: WE WILL NOT SEND COMPLAINTS TO PERSONAL EMAIL ADDRESSES. A
SHARED EMAIL ADDRESS MUST BE IDENTIFIED OR THE TRANSMISSION WILL
DEFAULT TO THE FAX NUMBER) Please identify the address/es to which we should
transmit our complaints:
Email: _________________________________ Fax:________________________________
Effective December 28, 2007