San Miguel Power Association, Inc.

Renewable Energy Subscription
GREEN BLOCKS

San Miguel Power Association

Offices: Nucla: 970-864-7311, Ridgway: 970-626-5549

I would like to participate in San Miguel Power’s Renewable Energy Program and hereby request to purchase the number of renewable energy blocks I have entered below (minimum 1 block = 100kWh).

Each block purchased will add $1.25 per block to my monthly electric bill. The Renewable Energy charge will be in addition to the normal rate I pay on my account.

* Number of New or Additional Blocks to Purchase:

Account Number:
* Phone Number:
* Name:
Service Address:

City:
State:	Zip:
Date:

By submitting this form, I agree to purchase the above number of renewable energy blocks for a one year term. If after one year I choose to no longer purchase Renewable Energy blocks, I will contact San Miguel Power Association and cancel my purchase. If I do not cancel my purchase, San Miguel Power Association will renew the purchase agreement for another year.
* I hereby apply to San Miguel Power Association for the purchase of renewable energy blocks in accordance with the terms and conditions contained in this application for renewable energy, all of which I agree to.
* required

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