Green Energy Termination Request Form

Please complete this form to terminate your participation in Fort Collins Utilities Green Energy Program.

1. Name:

2. Business name (if applicable):

3. Phone number:

4. Email: This question requires a valid email address.

5. Service address:

Street Address

Apt/Suite/Office

City

State

Zip

6. Account number (format: 123456-78910)

7. Enter multiple account numbers here (in the same format as above):

8. Participation options:

I no longer wish to participate in the program. Please cancel my subscription within 30 days. Reason for termination: Please enter an 'other' value for this selection. * This question is required.

9. Signature:

Clear

Signature of

10. Today's date: This question requires a valid date format of MM/DD/YYYY.

calendar

*PILOTs: A 6% PILOT (payment in lieu of taxes) has been added to electric, green energy, water and wastewater rates. This is a payment to the City’s general fund to replace revenue the City would receive from the Utilities in taxes and franchise fees if the utilities were privately owned. Without PILOTs, the Green Energy Program rate is 1.5 cents per kWh.