Customer Smart Grid Information Collection Form

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Service Address*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

How many people live in your household?*

YesNoNot Sure

Solar PanelsWind TurbineNoOther

YesNo

Morning (6am - 10am)Afternoon (10am - 4pm)Evening (4pm - 9pm)Night (9pm - 6am)

YesNoMaybe, I need more information

Please provide any additional comments or suggestions regarding your energy usage or smart grid experience.