Company Information Form

Engagement Letter and Retainer Details

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Account ID

Legal Name(Required)

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone(Required)

Business Fax

Business Email(Required)

Website(Required)

Executive or Primary Contact

Name(Required)

First Last

Title(Required)

Phone(Required)

Phone Extension

Email(Required)

If different from Signer

Name

First Last

Title

Phone

Company affiliates in Energy industry(Required)

Company affiliates NOT in Energy industry(Required)

Registered DBAs you intend to market services under(Required)

Registered DBAs you do NOT intend to market services under(Required)

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Comments

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