Common use of Interconnection Customer Signature Clause in Contracts

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: TitleFull Name Company Name Title With Company E-Mail Address Mailing Address: DateCity: State: Zip: County: Telephone (Day): Fax: (Evening): Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Contingent Approval to Interconnect the Generating Facility (For Authority use only) Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Authority Signature: Title: Date: Interconnection Request ID number: Utility Authority waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:

Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County: