Section 280.APPENDIX A   Disconnection Notice

Disconnection notices sent to customers shall be in red and substantially in the following form:

Issuance date:                                                                         Effective date:

Utility name                                                                            Customer name and address

Utility contact information                                                     Customer account number

URGENT!

This is a DISCONNECTION NOTICE!

Your utility service is in danger of disconnection because (reason for notice here, including past due amounts for which the service may be disconnected).

In order to stop disconnection, you must (detailed description of what customer must do in order to avoid disconnection; in lieu of detailed steps, utility may offer contact info where customer can immediately access complaint handling utility personnel). If you have recently paid, please contact us to confirm that the service will not be disconnected.

You can be shut off on or after (effective date), and you can still be shut off until (date notice expires) or we send you a new notice to replace this one.

Residential customers have certain rights regarding this notice, including the right to a deferred payment arrangement and the potential to stop disconnection for 60 days and start a medical payment arrangement if a doctor of local board of health contacts us directly on behalf of a patient living in your household. Please see the reverse side of this notice for further details of your rights.

You will lose many of your rights if you wait to do something until after disconnection.

If you have questions or concerns about this notice, please contact us immediately at: (utility contact information).

If we are unable to assist you, you have a right to contact and review your rights with the government agency that regulates us:

The Illinois Commerce Commission's Consumer Services Division can be reached at

1-800-524-0795 (TTY 1-800-858-9277).