Third Party Authorization

If you wish to be notified if a tenant is pending disconnect, please have the tenant sign the third party form attached. You will receive notice if they are pending disconnect so you can watch and make sure services are not interrupted.

Customer Name
First Last
Account Number
Address*
Street Address Address Line 2 City State ZIP Code
I request Chesapeake Utilities send a copy of the following for the above account to the third party information below.*
- Disconnection Notice
- Billing Statements
- Usage
Third Party Information
Name
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Consent*
I understand that they are not obligated to pay these bills.*
Customer Signature

Complete By Mail (optional)

If you would prefer to send a physical copy of this application, you can download the below form and mail to us:

Download Form

Third Party Authorization

Third Party Information

Complete By Mail (optional)

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