General Information *Customer/Facility Name:
*Facility Location(s):
*Description of Business:
*Name of Person Submitting Information:
*Job Title:
*Phone Number:
Fax Number:
*E-mail (required):
Facility Information Number of Buildings: Total Square Footage: Type of Building: Hours of Operation: Energy Studies Previously Performed (describe): Energy Projects Already Implemented (describe): Major Projects Planned (indicate time frame):
Utility Information Electricity Supplier: Annual Use (KWD): Peak Demand (KW): Natural Gas Supplier: Annual Use (MMBTU): Water Supplier: Annual Use (Gallons): Sewage Treatment: Annual Use (Gallons): Other Utilities:
Project Information Payback or Return on Investment Required: Interested in Turnkey Project?
Yes No
Interested in Project Financing through PPL?