FREE Power Quote Request
Yes, I am interested in Green Power for my business!
For a FREE quote from Clean Currents, fax this completed authorization form along with a copy of one electric bill from each meter to Clean Currents at 240-744-1719. Print this page or click here to download the word version. authorization_to_release_electricity_data
(Please include only one electric bill from each meter. Utility will provide the remaining 24 months upon receipt of this authorization form from your Clean Currents representative.)
AUTHORIZATION TO RELEASE ELECTRIC USAGE DATA
I hereby authorize the bearer of this release to request, on my behalf, up to 24 months of energy usage and demand information related to the accounts listed below, or attached. Please promptly transmit, electronically or via fax, the last 24 months of electricity data containing - by month - the following:
- KWh usage
- KW Demand
- Interval Data
- Rate Class
- Monthly Bills
1. Service Address For Clean Energy quote:
SERVICE ADDRESS:__________________________________________________
CITY/STATE/ZIP:____________________________________________________
METER NUMBER:_____________________________________________________
UTILITY:____________________________________________________________
SERVICE ACCT. NUMBER:_____________________________________________
2. Service Address For Clean Energy quote:
SERVICE ADDRESS:__________________________________________________
CITY/STATE/ZIP:____________________________________________________
METER NUMBER:_____________________________________________________
UTILITY:____________________________________________________________
SERVICE ACCT. NUMBER:_____________________________________________
3. Service Address For Clean Energy quote:
SERVICE ADDRESS:__________________________________________________
CITY/STATE/ZIP:____________________________________________________
METER NUMBER:____________________________________________________
UTILITY:___________________________________________________________
SERVICE ACCT. NUMBER:____________________________________________
(For more than three accounts, please list additional accounts on a separate sheet and attach it to this form.)
Name of Authorized Individual:_______________________________________
Title:_______________________________________________________________
Company (Legal Name):_____________________________________________
Legal Address:______________________________________________________
City:______________________________________State:_____ Zip:___________
Telephone:________________________________ Ext:______
Email Address:_____________________________________________________
Authorized Signature:________________________________Date:__________
Please submit this data to Gary Skulnik FAX: 240-744-1719 or email a .pdf to
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