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Green Generation Enrollment Form

Thank you for choosing to make a positive difference for our families, our communities, our environment, and future generations by enrolling in green generation ^sm! By submitting this form you will be enrolled in Consumers Energy's green generation ^sm program and will have a green generation ^sm charge added to your monthly energy bill. Please complete a separate form for each account you wish to enroll in green generation ^sm

* Indicates a required field

Initial 12-month term required. Your participation costs are in addition to your normal monthly electric charges.

Participation Level: (Choose one) - Need Help?

GreenTeam: 100% ($0.01667 per kilowatt-hour)
Your monthly participation costs will fluctuate as your electricity use changes.

GreenBlocks: x $2.50 each =
Enter your desired # of blocks per month to calculate your monthly participation costs.

GreenBusiness: x $2.00 each =
Enter your desired # of blocks per month to calculate your monthly participation costs.
You qualify for the discounted price shown above if you purchase 100 blocks or more.

Account Number:

Your account number is shown on the front of your monthly energy bill (no spaces).

Promotion Code:

Authorized By:

Your first and last name as shown on your energy bill.

Service Address 1:

Service Address 2:

City:

State:

Zip Code:

Daytime Phone:

Email Address:

How did you hear about green generation ^sm?

If an organization influenced your decision to enroll in green generation ^sm, please list that organization here:

Comments:

Please take time now to review the green generation ^sm program Content Label.

Please take time now to review the green generation ^sm program Terms and Conditions.

I have reviewed the green generation ^sm program Content Label which discloses the energy resources for the Green Generation program.

I have read, understand, and accept the green generation ^sm program Terms and Conditions and agree to be bound by them. I understand that by submitting this enrollment form, I will be enrolled in the Green Generation program and I agree to have the monthly participation charges added to my monthly Consumers Energy bill.

This Contract may be executed and delivered in counterparts, including by a facsimile or an electronic transmission thereof, each of which shall be deemed an original. Any document generated by the parties with respect to this Contract, including this Contract, may be imaged and stored electronically and introduced as evidence in any proceeding as if original business records. Neither party will object to the admissibility of such images as evidence in any proceeding on account of having been stored electronically.

Please refer to the Terms and Conditions for eligibility requirements. Customers can only enroll in one option at a time. If you have questions or would like more information, please contact us at (800) 241-3368, Monday through Friday, 8 a.m. to 6 p.m. EST.

Form 742 8-2009
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