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FlexTech Referral

Facility Name:
Address:
City:		State:	Zip:
Contact Person:
Title:
Phone:		Fax:
Email:
Electric Utility:
Gas Utility:
Total Annual Energy Costs:
Annual Cost by Source:
	Electricity:
	Natural Gas:
	Fuel Oil:
	Steam:
Electric Account Number:
Description of Needs, Potential Energy Conservation Measures, or Assistance Requested:

17 Columbia Circle, Albany, NY 12203-6399 Toll-Free: 1-866-NYSERDA or Local: 518-862-1090 Fax: 518-862-1091
New York City and Buffalo Regional Offices