The following concurrence form shall be used in concurring in rate schedules published by public utilities or their duly appointed agents published and filed with the Commission:
______________________________________________________________________________
(Name of public utility)
Date ______ , 19______
PA. T 2 No.
TO THE PENNSYLVANIA PUBLIC UTILITY
COMMISSION
Harrisburg, Pennsylvania 17120
THIS IS TO CERTIFY that (name of public utility) assents to and concurs in the publication and filing of any rate schedule or supplements thereto which (name of public utility) or its agent may make and file, and in which this company is shown as a participating company and hereby makes itself a party to and bound thereby insofar as such schedule or supplements thereto contain rates as described below:
__________________________________________
__________________________________________
__________________________________________
until this authority is revoked by formal and official notice of revocation placed in the hands of the Pennsylvania Public Utility Commission and of the company to which this concurrence is given. _______________________________________________________________________________________________
(Name of public utility)
By _______________________________________________________________________________________________
(Name of officer)
_______________________________________________________________________________________________
(Title of officer)
52 Pa. Code § 53.97