Dual Fuel Program Application

MEMBER INFORMATION

Name *

Account # *

Service Address *

City *

State *

Zip *

Phone Number *

Type of Phone *

Type of System *

Electric Storage Heat ((4.5¢/kWh)

Dual Fired Fully Auto System (5.8¢/kWh)

Air Conditioning (determined by heating rate above)

Type of Electric Heat *

Type of Back-Up Heating System *

Heating System Description *

Existing

New

Location of System *

House	Shop
Garage	Other Other

Approximate kW being Installed *

Type of Metering *

Direct Metering

Sub Metering

Rebates

MEMBER DUAL HEAT AUTHORIZATION

Approximate Completion Date for Dual Heat * +

Electrician *

Inspection Completed? *

Yes

No

I hereby certify that I will be responsible for periodic checks, maintenance and service to ensure that
the system is operating properly. TWEC will not be held liable for any loss that may occur due to
malfunction of the load management equipment or for a prolonged interruption causing economic
loss. All dual fuel accounts will be billed monthly.

Member Signature *

clear

Date * +

ELECTRIC HEAT SALES TAX EXEMPTION

I hereby certify that electricity used under this service provides more than 50% of my total residential
heating equipment and should be exempt from sale tax. If at a later date it has been determined
that this account is not exempt for any reason and it is necessary for TWEC to bill me for tax due, I
hereby agree to pay that amount.

Member Signature *

clear

Date * +

This institution is an equal opportunity provider and employer.