Property/Owner information
Property address : •
City: •
State:		MI
Zip code:
Date property purchased/sold: •
Date billing responsibilities changes: (If different than purchased/sold date)

Seller
Seller/Legal entity name:
Project/Division name (if applicable):
Seller’s mailing address:
City:
State:
Zip code:
Seller’s phone:
Fed. tax ID/SSN:

Purchaser
Purchaser/Legal entity name:
Project/Division name (if applicable):
Purchaser’s mailing address:
City:
State:
Zip code:
Purchaser’s phone:
Fed. tax ID/SSN:

Purchaser, please complete the following information

Owner agreement options
Indicate responsibility for energy service(s) by selecting one of the following options. (Review Disconnection Rules below prior to making your selection.)

Option 1 — All year agreement
I accept billing responsibility for energy service between tenants. By selecting this option, I will be billed for all energy usage between tenants unless I notify We Energies otherwise.

Option 2 — Lock/disconnect agreement
I do not want to assume billing responsibility between tenants. I request We Energies terminate service to the rental dwelling unit.

Option 3 — No permanent agreement
I do not want a permanent agreement. I understand that you will notify me a each tenant change and ask me to select whether I want energy service placed in my name or disconnected.

Please mail the bills to:
Purchaser’s mailing address shown above or
Address listed below:

Mailing address
Street address:
City:
State:
Zip code:

Disconnection rules

• If you choose to have service disconnected and the meter(s) are located inside the building or are otherwise inaccessible, you will
  need to provide access for our metering staff to disconnect the service(s).
• Under Michigan Public Service Commission Administrative Rule R460.2162(d)(i) for disconnections, we are required to verify that residential premises are vacant before disconnecting service.
• After each tenant change, we will need your written statement, under oath, that the premises are unoccupied before we can disconnect service.

Please list other Michigan residential properties you own that you would like to include in this agreement:

Property management company information (if applicable)
Company name:
Company mailing address:
City:
State:
Zip code:
Company contact name:
Contact e-mail address:
Contact phone:
Company fax number:
Tax ID/SSN:

New owner signature:
Form completer e-mail: •
Date: •