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Pacific Gas & Electric Company Claim Form

Claim form Mail To: Pacific Gas and Electric Company Attn: Law Claims Department 300 Lakeside Drive, Oakland, CA 94612 -OR- Email to: -OR- Fax to: 925-459-7326 Helpline phone: 415-973-4548 PLEASE PRINT Dr. Last Name First Name Spouse s Name Work Telephone ( )Home Telephone ( )Business name (if Claim is for business) PG&E Account Number Mailing Address - Street Apt. Number City Stat e Zip Code Email Address Date of Incident Time AM/PM Location of Incident (check If same as mailing address ) Description of Incident PROPERTY DAMAGE: Attach repair estimates, invoices, proof of purchase, or supporting documents. (Do Not Send Originals). FOOD SPOILAGE: Include a separate itemized list of each item of food spoiled and documentation of cost.

CLAIM FORM Mail To: PG&E Law - Claims Dept. 1850 Gateway Blvd. 6 th Floor . Concord, CA 94520-OR- Email to: LawClaims@pge.com-OR- Fax to: 925-459-7326

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