Chamber Energy Program - Intent to Participate Form

Company's Name:
Chamber Membership:

Intends to participate in the Chamber Energy Program and agrees to:

  1. Provide information on energy usage to the Chamber Energy Coalition, which will be kept confidential.
  2. Complete and sign release forms, which will allow the Chamber Energy Coalition to obtain historical consumption information directly from your utility companies. This information will also be kept confidential.
  3. Appoint a senior-level contact person.

Your company is not required to make any commitment at this time and this form is not to be construed as an obligation to contract for electricity with any party.

Street Address:

City: State: Zip:
Applicant's Name:first last
Applicant's Title:
Contact's Name:first last
Contact's Title:
Contact's Email:
Date:Mo DYR
Phone:() Fax:()

fax this form to (413) 567-4610
mail this form to
Chamber Energy Coalition, P.O. Box 15563, Springfield, MA 01115

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