Energy Usage Application Form

ENERGY USAGE APPLICATION FORM

Applicant Identification

Applicant Name:

WHEREAS — Recitals

WHEREAS, Applicant Name: seeks to obtain authorization for metered energy consumption and related services at the Service Address identified above; and

WHEREAS, Provider Name: administers energy supply, metering and billing services and requires Applicant to submit an application describing intended energy usage and agreeing to terms and conditions contained herein;

WHEREAS, the parties intend that approval of this application constitutes a binding agreement for energy service subject to the terms set forth below.

Scope of Use and Work

Describe the intended energy uses, equipment to be operated, estimated load characteristics and any special metering or interconnection requirements. Include peak demand expectations and seasonal variability.

Energy Profile / Load Information

Residential Commercial Industrial Agricultural

Supporting Information & Attachments

The Applicant certifies that the following documents are provided with this application (check all that apply):

Site plan showing meter and equipment location   Single-line electrical diagram   Historical or projected load profile   Proof of insurance

Payment Terms

Applicant agrees to pay for energy supplied and all applicable fees in accordance with the Provider's applicable rates and the following supplemental terms:

Monthly   Bi-monthly   Prepaid arrangement

Term and Termination

This Agreement shall commence on Start Date: and shall continue until End Date: unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for material breach if such breach is not cured within Notice Period: after written notice. Provider may suspend service for safety, non-payment or regulatory requirement without waiving other remedies.

Confidentiality

Each party shall hold confidential all non-public information disclosed by the other party that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure. Confidential information does not include information that is (a) publicly known through no breach of this Agreement, (b) rightfully received from a third party without restriction, (c) independently developed without reference to the confidential information, or (d) required to be disclosed by law or regulation, provided that the disclosing party is given prompt notice and, where permitted, an opportunity to seek protective measures.

Data Release & Metering Consent

Applicant authorizes Provider to collect and use meter data, consumption and billing information for billing, load analysis, and program administration. Applicant consents to release of such data to authorized agents and permitted third parties pursuant to applicable law:

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of Governing Law: without regard to conflict of laws principles.

Entire Agreement

This document, together with any attached exhibits, schedules and accepted application materials, constitutes the entire agreement between Applicant and Provider with respect to subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

Certifications and Applicant Representations

By signing below, Applicant certifies that the information provided herein is true, accurate and complete; Applicant has authority to request energy service at the Service Address; Applicant will comply with Provider rules, safety requirements and applicable laws; and Applicant will promptly notify Provider of any material changes to the energy usage or equipment described.

Additional Notes / Special Conditions

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