Please complete this form and fax to 847-823-0045 with a copy of a ComEd bill for each account.
Company Name: _________________________________
Address: _______________________________________
City: ____________________ State: _______ Zip:________
Contact name: _____________________________________
Contact Title: ________________________________________
Phone: _________________ Fax:_______________________
email address of primary contact:_______________________________
Completing and signing this form gives Energy Choices
the right to be your
exclusive agent for obtaining bids for electricity
starting in January, 2007.
Signature: ___________________________________________________________