POO - SmartPak Request 2010

First Name	*
Last Name	*
(The SmartPak can only be shipped to a home address served by Minnesota Power.)
Address Line 1	*
Address Line 2
City	*
State	*
Zip	*
Email
Phone		(no dashes/include area code)
Minnesota Power electric account # (Located on your electric bill)
	*
Do you have an electric hot water heater? (You must have an electric water heater to qualify for the Free SmartPak.)
		Yes No

I'd like to become a member of the Power of One® Energy Team		Yes No
You can become a member of the Power of One® Energy Team and qualify to receive information on special offers, new energy-saving products and savings, and learn from other team members about no cost/low cost ways to save energy.*
Please provide the following information. It will help us deliver information and offers that are right for you. Do you have the following:
Second Refrigerator or Freezer		Yes No
Electric Heat		Yes No
Number of computers in your home:

*We respect your privacy. Your name and information from this form will only be used to ship your order, request feedback, and track your participation in other conservation programs. You can request to be removed from the Power of One® Energy Team at any time.