Information Release Authorization
I authorize CleanChoice Energy to obtain and review information regarding the following information from the LDU: consumption history; billing determinants; utility account number; credit information; public assistance status; existence of medical emergencies, status as to whether I have a medical emergency, is human needs, elderly, blind or disabled and data applicable to cold weather periods under PSL 32 (3); and information pertaining to PSL 33, tax status and eligibility for economic development or other incentives. This information may be used by CleanChoice Energy to determine whether it will commence and/or continue to provide energy supply service to my account and will not be disclosed to a third party unless required by law. My Residential Supply Agreement and this Information Release Authorization shall constitute authorization for the release of this information to CleanChoice Energy. This Information Release Authorization will remain in effect during the initial term and any renewal term. I may rescind this authorization at any time by providing written notice thereof to CleanChoice Energy at 1055 Thomas Jefferson St NW #650, Washington, DC 20007, or by emailing CleanChoice Energy at email@example.com. CleanChoice Energy reserves the right to cancel the Residential Electricity Sales Agreement in the event I rescind this Information Release Authorization.