2. First Name
3. Last Name
5. Address
7. City
8. State
9. Zip
11. Account Number
12. Phone
14. Charges will be based on consumption.
16. Your agreement obligates this account for the monthly amount ordered above for 3 billing cycles. Participation will be automatically renewed at the end of each term unless a 30 day termination notification from the program is received by the participant.
18. Authorization*
    Type I AGREE if you agree with the terms and conditions stated above.
20. Source: Pure & Simple Wind Power Rate Schedule
    Pure & Simple Wind Power Rate Schedule
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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