Form Builder

Survey Date

Organization Name

Utility Type

EMC
Municipal
IOU

Website URL

Contact Information

Have there been any changes in Contact information since last submittal?

First Name

Last Name

Email Address

Phone Number

Please enter in the following format: ###-###-####

Respondent

Complete this section if the person submitting this form is different from the contact listed above.

First Name

Last Name

Email Address

Phone Number

Please enter in the following format: ###-###-####

Total Bill Excluding Taxes

Please provide the Total Bill Amount for electric residential bills for each of the consumptions listed below. Please do not indicate a cost per kWh, as this is automatically calculated from the cost provided to us. Be sure to include the base charge, any applicable fuel cost recovery charge, and exclude tax. Amount shown should be in dollars and cents (e.g. 30.60). 

Be sure to include the base/consumer charge, any applicable fuel cost recovery charge, and exclude tax.

Please calculate the total bill amounts with tariffs in effect on January 1 for Winter Surveys and July 1 for Summer Surveys.

500 kWh

Enter amount in dollars and cents without the $ sign. E.g. 100.25.

1000 kWh

Enter amount in dollars and cents without the $ sign. E.g. 100.25.

1500 kWh

Enter amount in dollars and cents without the $ sign. E.g. 100.25.

2000 kWh

Enter amount in dollars and cents without the $ sign. E.g. 100.25.

Effective Tariff

Tariff/Rate Schedule Utilized

Name/Number

Effective Date

This is the effective date of the tariff/rate schedule utilized

Calculations File

Upload a supporting calculations file