Chief Energy Officer Online Enrollment Form

First Name:* *

Last Name:* *

Title:* *

Organization:* *

Address:* *

City:* *

State:* * AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY

Zip:* * Invalid

Phone:* * Format (555-555-5555)

Fax: Format (555-555-5555)

E-mail Address:* * Invalid

Account 1

Account Number:*

Account Name:*

Account Address:*

Account City:*

Account State:* DCMD

Account Zip:*

5 accounts maximum

AGREEMENT AND ACKNOWLEDGEMENT:

I certify that the above information is true and correct, and I agree to verification of the information provided by a Pepco employee. I understand that a charge of $25.00/account per month for the first 5 accounts, $20.00/account per month for the next 5 accounts, and $15.00/account per month for any additional accounts will be applied to my monthly electric bill for this service. If data are available for daily update, and I choose to use that capability, I understand that an additional charge of $5.00 per month will be added to the monthly charge. I understand that I will be given at least thirty (30) days' notice of any price change. I understand that I may cancel this service at any time by contacting Pepco at (202) 872-2121, and that the charge for the last month of service will be prorated to the date of cancellation. I understand that Pepco reserves the right to cancel this program at any time.