STORAGE PROGRAM ENROLLMENT FORM

Date:

MM

DD

YYYY

Name:

First Name

Last Name

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email:

Phone:

(###)

###

####

BENCO Account #:

Please list the equipment you would like enrolled in the program:

For example: Electrical thermal storage, storage water heat, in-floor heat, etc.

Acknowledgement Agreement

By checking this box I acknowledge that I have read and understand the terms and conditions of the storage program at BENCO Electric Cooperative. I agree that systems / appliances enrolled in the program will be controlled by BENCO.

Yes