Green Mountain Energy Network

Utility Customer Non-Binding Pre-Subscription Agreement

Customer Information:
Customer Last Name:	Customer First Name:		Middle Initial

Business Name (if Commercial):

Service Address:

City:	State:	ZipCode:
		*
Home Phone:	Work Phone:
*	*
E-Mail Address:

Service Information:
Local Electric Utility:	ESID Number:

Local Gas Utility:	Gas Account Number:

Terms of Agreement:
The prospective customer by completion of this form is indicating an interest in future acquisition of deregulated supplies of electricity and/or natural gas from a supplier other than their local utility. When either Green Mountain Energy Network service and/or the prospective customer's local utility services are deregulated, the prospective customer agrees to allow a Green Mountain Energy Network Representative to contact them and provide them specific Terms & Conditions of the specific services that are available. The prospective customer will have the option at that time to accept or decline Green Mountain Energy Network's offer of service(s). There are no other obligations or exceptions incurred by the prospective customer as a result of this agreement. Your Green Mountain Energy Network Representitive is Randy Winters (1788), you may contact them at wintersgmrep@yahoo.com