| Name: |
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| Email: |
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| Phone: |
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| Street address of location being serviced: |
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| City: |
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| State: |
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| County: |
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| Postal Code: |
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| Company Name or "Residence" as applicable: |
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| Number of employees or occupants: |
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| Current electricity and gas supplier: |
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| Peak electricity price per kWH: |
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| Off-peak electricity price per kWH: |
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| Gas price per therm: |
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| Electricity demand surcharges (total for all meters): |
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| Total kWH monthly average: |
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| Total number of electricity meters in facility: |
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Please list the average monthly
electricity charge per meter: | |
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Would you be interested in monitoring
your energy usage in real-time from
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