Fronter & Closer Form

Basic Information
Client's Name*
First Last
Company (LEN)*
Email*
Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Does this person have multiple locations?*
- Yes
- No
If so, please type additional address here or use the below box to upload an ecxel sheet or file with the addresses.
File
Max. file size: 50 MB.
Electric Account Number / Customer ID*
Estimates Annual Usage*
Rate Class*
Utility Zone*
Is this customer currently contracted to an Energy Supplier?*
- Yes
- No
If so, what supplier?
If so, what is the end date?
Fronter Information
Fronter's Name*
First Last
Fronter's Email*
Closer Information
Closer's Name
First Last
Closer's Email
New Supplier
New Contract Start Date
New rate being contract (raw rate, no mils)
Amount of mils you are putting on the deal
Are you using Matrix or Custom pricing?
- Matrix
- Custom
Any notes or additional information?

Basic Information