Contract Start Date *

What date did your contract with your current supplier begin?

MM

DD

YYYY

Contract End Date *

When does your contract with your current supplier end?

MM

DD

YYYY

Pricing Type *

What type of pricing do you have with your current provider?

Fixed

Spot/MCPE/LMP

HeatRate

Other/Hybrid

Letter of Special Agency pertaining to Energy Information *

____________________ (“Company”) hereby designates and entrusts Verdigris Energy, LLC (“Consultant”) with limited agency authority as stated herein. Consultant is authorized to act on our behalf to request and gather information pertaining to electricity and natural gas supply and related services; Consultant is NOT authorized to obligate us to any costs, contracts or financial obligations. This authorization covers and includes only documentation and information necessary to understand past and future energy-related expenses, including, but not limited to: • Letters of authority (LOAs) authorizing suppliers to gather usage history from regulated utilities (at supplier expense) • Copies of existing or expired contracts for energy supply • Copies of existing contracts with aggregators, brokers or consultants • Utility billing history including historic usage, payment history and invoice copies • Copies of transportation agreements • Orders or instructions for tariff application • Copies of predominant use studies and similar tax-documentation • Other information related to electricity and/or natural gas usage • Offers for service, pricing and related proposal information • ID and Password for online information pertaining to the above items Requests from Consultant for this information should be treated as if it were coming directly from the undersigned. This letter shall expire one year from the date written above, or may be cancelled without notice at any time by the undersigned.

I agree

Name

First Name

Last Name

Office Phone *

(###)

###

####