Disclosure of Information to a Third-Party Consent Form

 If you have any questions about completing this form, please contact Customer Care  customercare@energyplus.ca or (519) 621-3530.

PART A: CUSTOMER INFORMATION

Please complete all applicable customer information in this section. 

PART B: CONSENT FOR DISCLOSURE OF INFORMATION TO THIRD PARTY

The above-noted customer hereby consents to the disclosure by Energy+ Inc. of the following account related information to the Third-Party. 

THIRD-PARTY INFORMATION

This section outlines who Energy+ is authorized to release customer account information to.

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