I hereby agree to participate in the Fort Collins Utilities

							                                                      Fort Collins Utilities Residential Green Energy Agreement
I hereby agree to participate in the Fort Collins Utilities Green Energy Program.* I understand that my electric bill will include an increase of
one cent per kilowatt-hour (kWh) to help cover the costs of purchasing renewable energy. I understand I will be notified of price changes and
will be given an opportunity to change my subscription at that time. I understand that if, at some time in the future, I am no longer a customer
of Fort Collins Utilities for any reason, I 	will be under no further obligation.
	        	       	         	       	                 	
Customer	Name	on	Account:	                                                  	                       	 	   	 		Phone:																																									(day)		                 (eve.)
																																									
Mailing	Address:		 	                      	       	        	            	       	         	          	          	           	           	           	           	      	         	     	
	
Service	Address:			                    	          	        	            	       	          	         	          	           	           	           	           	      	         	     	
		       	        	
Account	Number:		                      	          	        	        -   	       	          	         Signature:	            	           	           	           	      	Date:	   	     	

How	You	Heard	of	Program:	                        	        	            	       	          	         	          	           	           	           	           	      	         	     	

Contracted Level of Participation (*Special Services Agreement on back):
	 I	agree	to	purchase	the	equivalent	of	my	electricity	use	from	renewable	energy	for	the	account	number(s)	indicated	above,	plus	PILOTS.*
	 I	agree	to	purchase	_____	block(s)	of	renewable	energy	(1,000	kWh	per	block)	for	$10	per	block	per	month,	plus	PILOTS.*
	 I	agree	to	purchase	_____	block(s)	of	renewable	energy	(500	kWh	per	block)	for	$5	per	block	per	month,	plus	PILOTS.*
                                                                    WHITE	-	Utilities												YELLOW	-	Customer
                                                                	    	          	              	       	        	                                                                             	
                                           P.O.	Box	580		•		Fort	Collins,	CO	80522-0580		•		(970)	212-2900		•		FAX	(970)	221-6619					
4/07                                            TDD	(970)	224-6003		•		E-mail:	utilities@fcgov.com • www.fcgov.com/utilities
*Special Services Agreement:
The	subscriber	contract	period	is	one	year,	starting	when	customer’s	green	energy	service	begins.	Subscription	
extensions	will	be	automatic	for	one-year	periods	from	that	date.	To	terminate	the	agreement,	the	customer	must	provide	
30	days	advance	written	notice	to	Fort	Collins	Utilities.	The	Green	Energy	Program	may	be	discontinued	by	Fort	Collins	
Utilities	upon	the	giving	of	30	days	advance	written	notice.	This	service	is	provided	per	the	Renewable Resource	clause	
in	the	applicable	rate	tariff	and	is	subject	to	revisions	by	City	Council.	The	Green	Energy	product	will	be	made	up	of	
the	following	new	renewable	resources	averaged	annually:	100	percent	wind	generated	in	Wyoming	and	Oklahoma.	
The	remainder	of	the	electricity	contains	the	following	mix	of	resources:	coal	(74	percent),	large	hydroelectric	(19	
percent),	renewables	(3	percent,	as	called	for	in	the	Energy Supply Policy),	natural	gas	(1	percent)	and	other	(4	percent).	
The	Green	Energy	rate	is	subject	to	a	6	percent	“PILOT”	fee	(Payment	in	Lieu	of	Taxes),	which	is	the	equivalent	of	the	
property taxes and franchise fees a private utility would pay to the City for police, fire, parks and recreation, and other
services.	PILOTs	are	set	by	City	Council	and	are	added	to	electric,	green	energy,	water	and	wastewater	rates.