Letter of Authority to Act Please enable JavaScript in your browser to complete this form.Account Holder's Name *Contact Phone Number(s): *Contact Email Address: *As a part of our process of quoting energy pricing for your accounts, we require authority to act on your behalf with some retailers and other relevant parties. Please fill in the required information, sign below and return, giving our company Specialist Energy Management Pty Ltd (SEM) ACN 146 634 997 permission to act on your behalf within the following areas of your retail electricity and gas connections:Account set up. Novation - change of ownership. Energy pricing (electricity and gas). Tariff restructuring (when required). Energy Bills being sent to our office via our email address on request. Escalation of unresolved issues via the retailer.Escalation of unresolved issues via the relevant Ombudsman. Authorization for retailers to perform credit checks. Commission of up to 3% payable on raw energy rates C&I only. Any other matters relating to the effective management of your energy accounts. De-energize a site on request.Note that this LOA give SEM and the ability to source offers/contracts for you, but NOT to accept them. This LOA remains valid from the date of signing unless otherwise revoked in writing by you.Residential Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeYears at Residential Address *Date of Birth *ID: License / Passport *Expiry Date *Signed: *Clear SignatureSigned Date: *Submit Phone (03) 8751 2288 Fax: (03) 8751 2288 Email: admin@specialistenergy.com.au