Utility aggregation, buying groups, energy brokers for natural gas, electricity

Natural Gas Quote Request Form

Independent Energy Consultants, Inc. is a full service energy brokerage company. We negotiate with all eligible suppliers to find your company the best available rate, with terms and conditions that fit your risk tolerance and budget requirements. Please provide the information shown below to allow us to start the process of assessing your opportunity. An IEC representative will contact you within 24 hours to discuss your particular needs, our data requirements, and to answer your questions. Our services are provided FREE-OF-CHARGE to you and we will be there to assist you during the life of your supply agreement. Our only requirement of you, is that you accept our brokered offer should it be lower than our mutually agreed upon price-to-beat.

An IEC representative will need the following information to assist you in developing a procurement strategy and to seek customized quotes for your business. The more details you can provide the better we can do our job. At this stage, however, only the fields marked with an (*) are required.

Click here to access a PDF of this form if you prefer to fax the information at your convenience.

(*) Required Field.

Company Name*
Company Address Line 1*
Company Address Line 2
City*
State*
Zip*
Contact First Name*
Contact Last Name*
Contact Phone*
Contact Email*
Contact Fax
Dunn & Bradstreet Number
Local Utility*
Utility Rate Schedule
Current Supplier
Current Contract End Date
Desired Start Date

Price Options Desired
	Fixed		Fixed/Index	Index		Please Advise

Contract Term
	1-Year		2-Year	Other		Please Advise

Delivery Requirements
	Firm	or	Interruptible	Full Requirements	or	% Swing Volume

Monthly Usage for prior 12-months shown below is expressed in

January	February	March
April	May	June
July	August	September
October	November	December
Est. Annual Usage*
Note: To facilitate the customer switching process to a new supplier, additional information such as your account numbers, meter numbers (found on bill) and Dunn & Bradstreet number will be required at a later date.

820 Deepwoods Dr. | Aurora, Ohio 44202 | Toll Free: 888 862-6060 | Phone: 330 995-2675 | Fax: 216 274-9176