Please take a moment to fill out the information below and we'll have a analyst calculate your potential savings and contact you soon.

Industrial Facility

Publishing Load & Savings Evaluation Questionnaire

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Company Information:

Company Name:*

Contact Name:*

Title:

Email:*

Phone:

Note: All information supplied is confidential and will be for Powerit Solutions' use only and will not be distributed outside of Powerit Solutions.

Utility/Load Information:

Name of Utility:

Number of billed meters:

Utility Rate Schedules (This information can be found on your utility bill.):

Please fax or email a utility bill from the past 12 months.

If you are unable to provide utility bills please provide the following:

January:

Total kWh:

Peak kW:

Estimated Monthly Demand Charges:

April:

Total kWh:

Peak kW:

Estimated Monthly Demand Charges:

July:

Total kWh:

Peak kW:

Estimated Monthly Demand Charges:

October:

Total kWh:

Peak kW:

Estimated Monthly Demand Charges:

Please provide electronic kW interval data for 1 month, 12 months is preferred.

Operational Schedules (24x7, 8x5, etc.):

"On-Peak Operation" (10%, 50%, etc.)
Typically utility defined (Ex: 12pm to 6pm weekdays):

Do you currently have an energy management system?

Yes
No

If yes, please describe:

It is helpful for us to also evaluate a site map of your facility. We'll look for key installation locations such as furnace, power supplies, operator stations, network locations, etc. Please email or fax a single site map if possible.

Major Energy Consuming Loads:

Please complete the following table for each major load in the facility.

Identifier (Ex: Fan #1, Pump #2)	kW Load/hp Load (Ex: Ex: 800, 1200)	Typical Daily Run Cyle (Ex: 10min, 45min)	Is this load automated? (Yes / No)

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