For Electricity:
Please take a minute to fill out this form, to help us get a preliminary idea of your business needs. This information will be kept confidential.

* = Required Field

*Business name:

*Contact person:

*Description of business:

*Business phone number of contact person:

*Business fax:
(type "NONE" if you do not have a fax)

*E-mail address of contact:

*State and Utility:

*Rate class:

*Electricity kwh usage:
kwh Monthly Annual

Monthly usage:

January	Kwh
February	Kwh
March	Kwh
April	Kwh
May	Kwh
June	Kwh
July	Kwh
August	Kwh
September	Kwh
October	Kwh
November	Kwh
December	Kwh

*Desired contract term:

*What month do you want service to begin?

Current supplier:

Electricity kw demand (if applicable):
kw

How would you like to be contacted?

Business phone number above

Best time to call

E-mail

Business Fax