City of Momence - 2012 Ordinances and Resolutions - page 78

P.S. To receive these savings, you shouldnot respond. Return the
opt-out form only if youdonotwant toparti cipate in theCity' s
electric governmental aggregationprogram.
Option 1:Donothing and save.
If youwant toparticipate in this program and
save, youdonot need to return this form. Your
enrollment is automatic.
Option 2:Opt out by returning this form.
If youdonotwant toparticipate in this program,
youmust return this formbefore theduedate.
Service address (City, State, andZip)__________________________________________
Phone number: _______________
Account holder's signature:_____________________________________________________________________
Date: ______________________________