Customer Name:

City:

Zip Code:

Phone:
(i.e. 555-555-5555)

Fax:
(i.e. 555-555-5555)

Email Address:

Service Voltage Level:
Primary Service (12.47 kV or 24.94 kV)
Secondary Service (.120/.208 kV, .120/.240 kV or .277/.480 kV)

SIC#:
Standard Industrial Classification Code

Shifts Typical Operation:

Demand:
In Kilowatts

Power Factor:

Connected Load:
(KW/KVA)

Total Command Capacity:
(KW/KVA)

Firm Capacity:
(KW/KVA)

Non Firm Capacity:
(KW/KVA)

One Month's Energy KWH:

Contract Capacity:
Same as demand, (KW/KVA)

Summer/Winter:
(KW/KVA)

List all motors with horsepower greater than 10:

Number of Main Breakers (Include sizes and amps):

Your confidential quote will be mailed to you within five (5) business days. The rate quote provided will be based on the energy service information provided by the customer and calculated on the effective applicable rate schedule, effective energy cost adjustment, any stated assumptions on information either not known or not provided, current effective applicable taxes and does not represent a warranty nor guaranty of a customer's actual billing.