Business Name:

Street Address: City : Postal Code:

Phone: Fax: E-Mail:

Owner's Name: Business Type: Sole Proprietor Partnership Corporation

Partner(s) Name:

Main Contact Person: Number of Years in Business:

Has there been any added electrical equipment within the last THREE years? Yes No (If YES please explain below)

Is there currently a Power Factor Correction unit installed at the main service entrance? Yes No (If YES please explain below)

Overall, have there been any changes to your business within the last THREE years that might have affected the power usage of your facility? Yes No (If YES please explain below)

Please fill in the following information

Average Monthly Hydro Bill: Any Equipment Down Time:

Sq. Ft. of Facility: Number of years at location:

Hours of Operation: Height of Ceilings:

Type of lights being used including wattage and voltage:

Please check the top THREE issues that affect your business the most:

Power Surges:                                    Lightning Strikes: Refrigeration Equipment Maintenance:

Electrical Equipment Maintenance        Type of lights being used including the wattage and voltage:

Telephone and Cable Equipment Failures:    Height of Ceilings: Any Hydro Supply Contracts:

Additional notes: