General

Company Name:   _________________________________________                               Type of Business:  __________________________

Address:                _________________________________________                                If Hotel, # of Rooms:  ______  If Hospital, # of Beds:  ______

                                _________________________________________                                State Tax ID #:  _____________________________

                                _________________________________________                                Federal Tax ID #:  ___________________________

Primary Contact:

Name:______________________________Title: ______________________________Email: ______________________________

Phone #:_____________________________Fax#:______________________________

Maintenance Contact:

Name:______________________________Title: ______________________________Email: ______________________________

Phone #:_____________________________Fax#:______________________________

Accounts Payable Contact:

Name:______________________________Title: ______________________________Email: ______________________________

Phone #:_____________________________Fax#:______________________________

Telephone System Contact:

Name:______________________________Title: ______________________________Email: ______________________________

Phone #:_____________________________Fax#:______________________________
 

General Questions:

Do you have any utility and/or telco Contracts in place? ___Yes ___No
If yes, please include a copy.

Have you had any major renovations in the past 6 months or will you in the next 6 months?     ___ Yes  ___ No

If yes, at what location(s): ____________________________________

_________________________________________________________             
Have you closed any facilities/buildings in the past year or will you in the coming year? ___ Yes  ___ No

If yes, at what location(s) and when:

_________________________________________________________
_________________________________________________________

Have you opened any facilities/buildings in the past year or will you in the coming year?  ___Yes   ___ No

If yes, at what location(s) and when:

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 

Utility Questions:

Do you have an alternative fuel source available?     ___ Yes  ___ No

If yes, at what location(s): ____________________________________

Do you have any cooling towers/deduct meters?       ___ Yes  ___ No

If yes, at what location(s): ____________________________________

Do you irrigate any fields, lawns, etc.?     ___ Yes  ___ No

If yes, at what location(s): ____________________________________

Are any buildings electrically heated?                ___ Yes   ___ No

If yes, at what location(s): ____________________________________

Do you own any electric transformers?                ___ Yes   ___ No   

If yes, at what location(s): ____________________________________

Telecommunication Questions:

Type of Phone System:  _____________________________________ 

Type of Voicemail System: __________________________________

Type of Call Accounting System (if applicable): _________________________________________________________

Who is Property Management System with (if applicable): ____________________________________________________

System Vendors: ___________________________________________________

Please attach any special contracts that you have with utility and/or telecommunications providers, including all contracts with brokers or marketers.
(If none are attached, audit will be performed based on the assumption that no contracts exist.)