Spreadsheet: 6ab106c4-d178-44a2-90ef-b6fb5285e338
Sheet: Sheet1

Unnamed: 0 | Combined Heat and Power - Customer Prospect | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Version: 12/23/2010 | Unnamed: 12
 | Instructions: [NAME] electronically.  Type information in yellow boxes.  Blue boxes use drop down list. This is a two page form.
 | Customer Name:
 |  |  |  |  |  |  |  | Phone No: |  |  | [NAME]:
 | Completed By: |  |  | Date:
 |  |  |  |  |  |  |  | Other Facility Type:
 | Facility Type:
 | Electric Company:
 | Electric Account No:
 |  |  |  |  |  |  |  | Utility Consumption Data: Enter in yellow boxes (Note 1)
 |  | Electric Service Address: |  |  |  |  | Usage Month (Note 2) | Billing Year | Electric, kWh | Natural Gas, therms | [NAME] consumption (rather than deliveries Note 3) | Oil Therms (Approx. depending on oil type)
 | Street: |  |  |  |  |  | Jan |  |  |  |  | 0
 | City, State, [NAME]: |  |  |  |  |  | Feb |  |  |  |  | 0
 |  |  |  |  |  |  | Mar |  |  |  |  | 0
 | Gas Company: |  |  |  |  |  | Apr |  |  |  |  | 0
 |  |  |  |  |  |  | May |  |  |  |  | 0
 | Gas Company Account No: |  |  |  |  |  | Jun |  |  |  |  | 0
 |  |  |  |  |  |  | Jul |  |  |  |  | 0
 |  | Customer Contact Information: |  |  |  |  | Aug |  |  |  |  | 0
 | Contact Name: |  |  |  |  |  | Sep |  |  |  |  | 0
 | [NAME]: |  |  |  |  |  | Oct |  |  |  |  | 0
 | Phone Number: |  |  |  |  |  | Nov |  |  |  |  | 0
 |  |  |  |  |  |  | Dec |  |  |  |  | 0
 |  |  |  |  |  |  |  | Total | 0 | 0 | 0 | 0
 |  | Vendor Contact Information (if applicable): |  |  |  |  | Note 1: Facilities which (prior to the installation of CHP) use more than 100,000 therms of NG or Oil AND consume more than 1,000,000 kWh per year of electricity may be a good CHP candidate (depending on other considerations).  However, facilities with lower consumption may also qualify.
 | Name:
 | [NAME]: |  |  |  |  |  | Note 2: Assign the consumption data to the month where most of the usage occurs - which may be different from the billing months.
 | Phone Number:
 |  |  |  |  |  |  | Note 3: Estimated monthly consumption.  Do not simply list Gals delivered during a month as consumption may carryover to future months.
 | Customer Authorizations (sign one or both items below):
 | 1) | Customer authorizes release of utility billing and other data to third parties to analyze the CHP or other Energy Efficiency feasibility.
 |  | Customer's Signature |  |  |  | Title |  |  |  |  | Dated
 | 2) | Customer authorizes Utility/PA to refer customer lead to one or more Approved CHP Vendors for follow-up.
 |  | Customer's Signature |  |  |  | Title |  |  |  |  | Dated
 |  |  |  |  |  |  |  |  | Enter "X" for all that apply
 |  | Building Energy Efficiency Measures |  |  |  |  |  |  | End Uses
 | Planned, Construction, or Installed | Date | Application Number | List Measures |  | Equipment providing uses |  |  | Space Heating | Domestic Hot Water | [NAME] | Process
 |  |  |  |  |  | [NAME] Central Boiler - Steam
 |  |  |  |  |  | [NAME] Central Boiler - Hot Water
 |  |  |  |  |  | [NAME]
 |  |  |  |  |  | Rooftop HVAC
 |  |  |  |  |  | [NAME]
 |  |  |  |  |  | Steam Absorption Chiller
 |  |  |  |  |  | Enter Other
 |  |  |  |  |  | Enter Other
 |  |  |  |  |  | Direct Gas Fired Equipment not Included in the Above List:
 |  |  |  |  |  | If other (or need more space), type in ======>
 | Supplemental Information: | Attach data for third party supplier(s) of electric and natural gas including agreed rates and length of agreement.
 | Enter Comments:
 | For Internal Use by Utility/PA Only
 | Reviewed by: |  |  | Date: |  |  | Marketing Opportunity ID:
 | Potential Feasibility: |  |  | Date: |  |  | Electric Circuit Serving Customer:
 |  | [NAME]
 | Lead given to: |  |  |  |  |  | Assigned Prospect #: