Wellspring Application Form

Yes! I want to participate in the Wellspring renewable energy progam.

Please indicate the number of 100 kilowatt-hour Wellspring wind energy blocks you wish to purchase each month. Each block will cost an additional $2 monthly over your base cost of electricity and represents your investment in the environment and in the future of renewable energy.

( ) 1 block (100 kilowatt-hours per month)

( ) 2 blocks (200 kilowatt-hours per month)

( ) 3 blocks (300 kilowatt-hours per month)

( ) 4 blocks (400 kilowatt-hours per month)

( ) 5 blocks (500 kilowatt-hours per month)

( ) Other: please specify the total number of 100 kilowatt-hour blocks you wish to purchase each month.

I understand that my commitment is for one year and will continue on an annual basis until I notify you in writing to end my participation in the Wellspring program. I also understand that no charges will be made to my account until November, when this sign-up period ends.

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Print Name

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Address

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City/State/Zip

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Signature

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Account No

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Day Phone

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Evening Phone

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Date

Print off this page, complete it, and mail to:
North Itasca Electric Cooperative
P.O. Box 227
Bigfork, Minnesota 56628