4. 
7. Voluntary Renewable Energy Application
9. Application date *
   Application date
11. Confirm you're eligible
    You must have an active utility account with the City of Ellensburg.
13. Provide your City of Ellensburg utility account information
15. Service Account Number*
16. Name*
18. Address*
20. City*
21. State*
22. Zip*
24. Email Address*
25. Phone Number*
27. Check box(es) below to indicate which option you would like:
29. Option A - $3.00/month/unit for locally generated renewable energy.

    1. 1 unit for $3.00/mo.
    2. 2 units for $6.00/mo.
    3. 3 units for $9.00/mo.
    4. 4 units for $12.00/mo.

    1. 5 units for $15.00/mo.
    2. 6 units for $18.00/mo.
    3. 7 units for $21.00/mo.
    4. 8 or more units - we will contact you

    ***Must be a current City electric customer.
31. Option B - Min. $3/month to maintain the City's Renewable Energy Park and provide renewable energy education.
    -- Select One --$3.00/month$6.00/month$9.00/month$12.00/month$15.00/month$18.00/month
32. Option C - A one-time donation to support the City's Renewable Energy Park.
    Please enter the amount you wish to donate. Note this is a one-time donation.
34. By selecting "I Agree" you agree that the provided name and account information is correct, you also agree that your City of Ellensburg utility account will be billed for the selection you have made.*

    1. I Agree
    2. I Do Not Agree
36. Contributions
    Contributions are deductible to the extent permitted by law. Please consult with your legal or tax advisor.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

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