Company Name: _________________________________________________________ Utility Code: _______________________________ Contact Person: _______________________________ Voice Phone Number: (____)__________________________ FAX: (____)__________________________ E-mail address: __________________________________________________________ Authorized Signature: Date: Please direct any questions regarding the TRS Surcharge remittance to Mr. Eric Jeschke at (717) 7833850 or ejeschke@pa.gov.
Company Name: _________________________________________________________ Utility Code: _______________________________ Contact Person: _______________________________ Voice Phone Number: (____)__________________________ FAX: (____)__________________________ E-mail address: __________________________________________________________ Authorized Signature: Date: Please direct any questions regarding the TRS Surcharge remittance to Mr. Eric Jeschke at (717) 7833850 or ejeschke@pa.gov.
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