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Authorization Form for Release of Information:

In order to generate a quote tailored to your needs and consumption pattern, Intelligent Energy® must obtain certain information about your account. Once we receive this information, we will be able to generate your quote and will make you our best possible price offer. THIS IS NOT AN AUTHORIZATION FOR ENROLLMENT. Intelligent Energy® will notify you of your price offer by telephone at the phone number you provided within seventy two hours of your request.

Contact Information:
Full Legal Name*
Business Name
Contact Phone*
Contact Fax
Email*
Gas Distribution Utility
Current Gas Account Number

Current Service Address:
Street Address*
City/Town*
State
Zip Code*

This Authorization allows Intelligent Energy® to obtain credit and utility information including, historical and future usage, meter readings, types of service, payment information and any other information required by the utility including, but not limited to, any additional or new account number(s). This information will be used for the purpose of determining the best current price available to You (the "Customer" or "You").

By pressing "Submit" you are authorizing a one time release of the above information to Intelligent Energy®. You have the right to rescind the authorization for release of the above information at any time by contacting Intelligent Energy® as indicated below.

As a duly authorized account holder and being 18 years of age or older, I have read and understand the above disclosure and voluntarily authorize Intelligent Energy® to obtain my credit and utility information.

For any questions, comments or if you need assistance,
please contact Intelligent Energy®:

Phone: 877-IVE-GOT-GAS (877-483-4684)
E-mail: Sales@IntelligentEnergy.org
Toll-free fax: 866-733-1115

Mail:
Intelligent Energy®, Marketing Department
7001 SW 24th Avenue
Gainesville Florida, 32607-3704

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