Customer
Name |
___________________________________
(As it appears on your electric bill) |
Business Name/DBA
(if any) |
___________________________________
|
| Type of Business |
___________________________________
|
| Service Address |
__________ State _____ Zip _______ |
| City |
__________ State _____ Zip _______ |
| Mailing Address |
___________________________________
|
| City |
__________ State _____ Zip _______ |
| Contact Name |
___________________________________
|
| Phone Number |
__-____-_____ext_____
|
| Hours of Operation |
___________________________________
|
| Times Available for Audit |
___________________________________
|
| FAX Number |
__-____-_____
|
| Email Address |
___________________________________
|
| Account Number |
___________________________________
(As it appears on your electric bill) |
| |
