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CA$HBACK customer information form

CA$HBACK Emergency Program Customer Information Form

Please fill out the following information:

* Required fields.

 Customer Information

 

 * Business Name

 

 * Service Address

 

 * City

 

 * State

 

 * ZIP

 

  * Account Number

 
   

   . . . . . . . . . . . . . . . . . . . . . . . . .

 

 Curtailment Contact Information

 

 Primary Contact

 

 * Name

 

 * Email Address

 

 * Confirm Email Address

 

 * Work Phone

 

 Cell Phone

 
   

 Secondary Contact

 

 Name

 

 Email Address

 

 Confirm Email Address

 

 Work Phone

 

 Cell Phone

 

 

By submitting this form you confirm participation in the CA$HBACK Emergency Program
with NYSEG and that you are not enrolled in another demand response program with another
curtailment service provider.