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5. Xcel Consent to Disclose Utility Customer Data MNCSCONSENTFORM ..................................................................................................................................................................................... Consent form instructions for the entity requesting customer data: The requesting entity must use this form to obtain authorization from any XceI Energy customer for the release of that customer's data to the entity. The requesting entity must populate the form by providing all of the information specified in the instructions and appropriately marking all applicable checkboxes. The entity must provide the completed form to Xcel Energy customers whose data the entity is seeking to obtain. A separate consent form must be provided for each Xcel Energy customer service address for which the entity is requesting data. The entity requesting customer data must provide the following information on the form prior to providing the form to the customer (refer to the corresponding fields within the form): (1) Specify requesting entity's details, including contact person whom the customer may contact with questions. (2) Identify details about the information you are requesting by populating the type of service, time period for measuring energy usage data and any other unique data element not otherwise listed on the consent form. (3) Describe the purposes of proposed use of customer data; the description must be detailed and sufficiently clear to inform the customer and Xcel Energy of the purposes for which the data will be used. (4) Specify date or event of consent termination, if the consent period is different from three (3) years. If any of this information is not provided, or the form is otherwise incomplete, it will not be accepted by Xcel Energy. CONSENTFORM ................................................................................................................................................................................... .. 2 (1) Requesting entity name: Contact person: Physical & mailing address: Phone:( ) Fax:( ) Email: CONSENT TO DISCLOSE CUSTOMER DATA We — the entity identified above — have asked you to authorize Xcel Energy to disclose your customer data to us so that we may: ❑ Provide you with products or services you requested ❑ Offer you products or services that may be of interest to you ❑ Determine your eligibility for an energy program ❑ Analyze your customer data ❑ Other (specify): (2) INFORMATION WE ARE REQUESTING We are requesting access to your customer energy usage data, which is customer -specific information that is collected from your ❑ Electric ❑ Steam ❑ Natural gas utility meter by Xcel Energy. Depending on the type of utility meter installed at your premises, this information may include: total energy use per billing period; average energy use per day; measured and billed demand; interval data collected via an Advanced Metering Infrastructure (AMI) meter or an Interval Data Recording (IDR) meter; and ❑ other (specify): for the period ❑ one month __/ ___ or ❑ 12 months, ❑ 24 months or ❑ 36 months starting from (mm/yyyy) (mm/yyyy) In addition to the energy usage data described above, the customer data report we receive from Xcel Energy may also include your name; account number; service number; meter number; service address; premise number; premise description; meter read dates; number of days in the billing period; utility invoice date; base rate bill amount; other charges including base rate and non -base rate adjustments; electric service sub -total; taxes; electric invoice total amount; and ❑ other (specify): HOW WE WILL USE YOUR CUSTOMER DATA The entity requesting your customer data will use the information to: (3) CUSTOMER'S CONSENT Your information is treated as private by Xcel Energy. You are not required to authorize the disclosure of your customer data, and your decision not to authorize the disclosure will not affect your utility services. Note that Xcel Energy will have no control over the data disclosed pursuant to this consent, and will not be responsible for monitoring or taking any steps to ensure that the data recipient maintains the confidentiality of the data or uses the data as authorized by customer. By signing this form you acknowledge and agree that you are the customer of record for this account and that you authorize Xcel Energy to disclose your customer data as specified in this form. This consent is valid valid for three years or through (4) or until you terminate your service, or withdraw consent by sending a written request with your name and service address to Xcel Energy at P.0 Box 8 Eau Claire WI 54702 or datarequest@xcelenergy.com. You may terminate this consent at any time. CUSTOMER ACCOUNT NUMBER SERVICE ADDRES SIGNATURE OF CUSTOMER OF RECORD PRINTED NAME �& Xcel Energy® DATE SIGNED RESPONSIBLE BY NATURE® xcelenergµcom I © 2012 Xcel Energy Inc. I Xcel Energy is a registered trademark of Xcel Energy Inc. 1 12-00-006 Northern States Power Company -Minnesota, Northern States Power Company -Wisconsin, Public Service Company of Colorado and Southwestern Public Service Company, Xcel Energy Companies.