Voluntary Renewable Energy Application - Existing Electrical Customers

2. 

3. Voluntary Renewable Energy Application

5. I want to be 100% renewable & carbon free
   The City of Ellensburg's electrical power is 97% carbon free. If you use 3,333 kWh or less of electrical power per month (national average per household is 1,000 kWh/mo), you can be 100% renewable and carbon free by adding a $3/month (per unit or 100kWh) to your electric bill. There is a limited number of renewable energy units available, so sign up today!

   The City of Ellensburg's electrical power is 97% carbon free. If you use 3,333 kWh or less of electrical power per month (national average per household is 1,000 kWh/mo), you can be 100% renewable and carbon free by adding a $3/month (per unit or 100kWh) to your electric bill. There is a limited number of renewable energy units available, so sign up today!

7. Provide your City of Ellensburg utility account information

9. Name*

10. City of Ellensburg Electric Account #*

12. Address1*

14. Address2

16. City*

17. State*

18. Zip*

20. Email Address*

21. Phone Number*

23. I'd like to sign up to be 100% renewable and carbon free for an additional $3/month on my electric utility bill (one unit)*

    ***Must be a current City electric customer.

    1. Yes
    2. Yes, but I'd like to buy more than one unit
25. I want to purchase additional units of renewable energy for $3/month per unit. **Must be a City of Ellensburg electric customer.

    1. A total of two units - $6/month
    2. A total of three units - $9/month
    3. A total of four units - $12/month
    4. A total of five units - $15/month

27. I want to contribute to the maintenance of the City's Renewable Energy Park and help provide renewable energy education.

    1. A total of one unit - $3/month
    2. A total of two units - $6/month
    3. A total of three units - $9/month
    4. A total of four units - $12/month
    5. A total of five units - $15/month

29. NOTE: If submitting this form electronically, please type your name and date on the corresponding lines above. Please review the electronic submittal disclaimer, and check box to acknowledge.

31. ELECTRONIC SUBMITTAL
    By placing your typed initials in the box, typing your name and date in the applicant/citizen signature field, and submitting this form electronically, I CERTIFY that all the information I am providing on this form is true and correct to the best of my knowledge. I also understand that my electronic signature is legally binding as if I were physically signing the form. I understand that any material misrepresentation, omission or falsehood may result in rejection or nullification of my application.

    By placing your typed initials in the box, typing your name and date in the applicant/citizen signature field, and submitting this form electronically, I CERTIFY that all the information I am providing on this form is true and correct to the best of my knowledge. I also understand that my electronic signature is legally binding as if I were physically signing the form. I understand that any material misrepresentation, omission or falsehood may result in rejection or nullification of my application.

33. Place your initials in the box below

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

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