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2. Date to begin service*
   Date to begin service
4. Service Property*

   1. Rent
   2. Own
6. Type of Business*
8. Tax Exempt?*

   1. Yes
   2. No
10. Business Name*
11. Phone Number*
13. Service address*
14. River Falls, WI 54022
16. Mailing address
    If different than service address. Include Street/PO Box, City, State, Zip
18. CONTACTS:
20. Business Owner*
21. Phone*
22. Email
24. On-site Manager*
25. Phone*
26. Email
28. Accounts Payable*
29. Phone*
30. Email
32. Emergency contact*
33. Phone*
    Emergency Contact's Phone Number
35. 
36. Renewable Energy Block Program

    1. YES, I agree to purchase 1 Block of Renewable Energy at $2.00 per month. Clean, affordable, "never running out" power from natural resources like wind, solar and biogas.

    This purchase will appear as an additional charge on my monthly utility bill. Additional blocks are available for $2/block. I understand that we can change our participation level or cancel at any time.

38. I agree to abide by the rules and regulations set forth by this utility and to pay for services at the specified rate. Utility rules require that assigned rate schedules remain in effect for a minimum of twelve (12) months. I understand that a non-payment of utility bills could result in interrupted service and require posting of a deposit. It is understood that current copies of the utility rules, regulations and rates are on file at the utility office and available to me for my information. Upon termination of this service, I understand that it is my responsibility to notify the Utility to request my utility service be terminated or changed from my name.
40. Customer Signature*
41. Date*
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field