First Name Last Name Business Name Service Address 1 Service Address 2 City State - - Choose One - - AL AK AZ AR CA CO CT DC DE 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 RI SC SD TN TX UT VT VA WA WV WI WY Zip Email Address Phone Fax Minnesota Power Account No. Federal Tax ID/SSN Number of Employees Type of Facility Agriculture Church Convenience Store Educational Fast Food Grocery Health Care Industrial/Manufac. Lodging Multi-family Office Retail Warehouse Other---   Please check the programs you are interested in: Energy Conservation Rebate Energy Analysis Project Assistance ENERGY STAR® Benchmarking Other--   Submitted by Customer Contractor Referral If Contractor Referral, please select applicable organization Ecolibrium3 Energy Insight, Inc. Energy Smart Franklin Energy Other-- Notes