5 - Date Submitted: Name of Electric Supplier: (including d/b/a, if any) Company website: Company Address: Docket Number: Contact Person for Customer Service: Contact Person for RPS Compliance matters: Name: Name: Address: Address: Phone: Phone: Email: Email: Contact Person for the Reporting of Gross Contact Person for general Regulatory Revenues and annual assessment pursuant to Compliance matters: C.G.S. §16-49: Name: Name: Address: Address: Phone: Email: Email:
5 - Date Submitted: Name of Electric Supplier: (including d/b/a, if any) Company website: Company Address: Docket Number: Contact Person for Customer Service: Name: Address: Phone: Email: Contact Person for RPS Compliance matters: Name: Address: Phone: Email: Contact Person for the Reporting of Gross Revenues and annual assessment pursuant to C.G.S. §16-49: Name: Address: Phone: Email: Contact Person for general Regulatory Compliance matters: Name: Address: Email:
Electric_Supplier_Contact_Information_form.docx