Preliminary Interconnection Site Review Request

Customer Information

Name*

Contact Person*

Mailing Address*

City*

State*

Please Specify

Zip Code*

Facility Location (if different from above)

Daytime Phone*

Evening Phone

E-Mail Address*

Fax

Is requested point of interconnection the same as an existing electric service?*

Yes No

Electric Service Account Number*

Additional Customer Accounts to be credited with Net Excess Generation

Annual Energy Requirements (kWh) in the previous twelve (12) months for the account physically attached to the Net-Metering Facility and for any additional accounts listed (in the absence of historical data reasonable estimates for the class and character of service may be made)*

Type of Facility (check one)*

Customer-owned Leased Service Agreement

Please Specify

Owner Information

Name

Contact Person

Mailing Address

City

State

Please Specify

Zip Code

Daytime Phone

Evening Phone

E-Mail Address

Fax

Generation Facility Information

System Type (check all that apply)*

Please Specify

Generator Rating (kW) DC*

Inverter Rating (kW) AC*

Expected Capacity Factor*

Expected annual production (kWh) of the facility calculated using industry recognized simulation model (PVWatts, etc.)*

Interconnection Information

Customer-Site Load (kW) at Net-Metering Facility location (if none, so state)*

Interconnection Request (choose one)*

Single Phase Three Phase

Please Specify

Signature

I hereby certify that, to the best of my knowledge, all the information provided in this Preliminary Interconnection Site Review is true and correct.

Net-Metering Owner Name*

Solar Company Representative*

Solar Company Name*

Solar Representative E-Mail*

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Easily pay
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Your Account at
Your Fingertips

Quickly Report
an Outage

Monitor your
Energy Usage

Easily pay
your bill

$2,000 Scholarships Available!

Monitor your Energy Usage

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