Reliable Energy can save you money. To obtain your free market analysis, please complete the Account Information, Natural Gas Profile, and Electric Profile sections of this form. Please note that a separate form must be completed for each account to be analyzed.

Upon receipt, your information will be forwarded to one of our qualified account managers for review.  You can expect to hear back from us with the results of our analysis within 7-10 business days. If you would prefer to speak directly with one of our account managers, simply complete and submit the Account Information portion of this form.

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Account Information

Company Name:

Contact Name:

Address:

Address Line 2:

City:

State:

Zip:

Phone:

Fax:

E-mail:

Profile of Natural Gas Use

Unit of Measure:

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Natural Gas Utility:         Current utility tariff rate:

Current Natural Gas Supplier (if applicable):

Contract Expiration (if applicable):(month/year)

Profile of Electric Use

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

KWH

Monthly Billing Demand (if applicable):

Service Voltage: (i.e. Primary, Sub-transmission, Transmission)

Electric Utility:         Current utility tariff rate:

Current Electric Supplier (if applicable):

Contract Expiration (if applicable):(month/year):

Additional Comments:

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