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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:

  

 * E-mail Address:

  

 * Confirm E-mail Address:

  

 * Work Phone:

  

 Cell Phone:

  
 

 Secondary Contact

  

 Name:

  

 E-mail Address:

  

 Confirm E-mail 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.