Letter of Authorization (LOA) for the Request of Historical Usage Information Form
Broker Number
*
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Select Transmission and/or Distribution Service Provider (TDSP):
*
ONCOR
CenterPoint
AEP North
AEP Central
TNMP
LP&L
Service Locations
Rows
Service Address
ESI ID
Service Location #1
Service Location #2
Service Location #3
Service Location #4
Service Location #5
Service Location #6
Service Location #7
Digital Signature
Customer Signature
*
Company Name
*
Customer Name
*
Title
*
Billing Street Address
*
City, State, Zip Code
*
Telephone Number
*
Format: (000) 000-0000.
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