Form Rpu-10 - Energy Efficiency Program Payment Form
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Illinois Department of Revenue
RPU-10
Energy Efficiency Program
Payment Form
Station 265
Do not write above this line.
Step 1: Identify the business
1
3
____________________________________________________
___ ___ ___ ___ ___ ___ ___ ___
Name
Illinois business tax (IBT) number
2
4
____________________________________________________
____________________________
Number and street
Daytime telephone number
____________________________________________________
City
State
ZIP
Step 2: Write the amount paid
5
Write the amount you are paying for your share of funding for the Energy Efficiency Program.
$__________________________
6
Make your remittance payable to “Illinois Department of Revenue.”
Mail your payment to:
ENERGY EFFICIENCY PROGRAM
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
This form is authorized by the Renewable Energy, Energy Efficiency, and Coal Resources Development Law of 1997. Disclosure of this information
RPU-10 front (N-5/98)
is REQUIRED. Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3833
Illinois Department of Revenue
RPU-10
Energy Efficiency Program
Payment Form
Station 265
Do not write above this line.
Step 1: Identify the business
1
3
____________________________________________________
___ ___ ___ ___ ___ ___ ___ ___
Name
Illinois business tax (IBT) number
2
4
____________________________________________________
____________________________
Number and street
Daytime telephone number
____________________________________________________
City
State
ZIP
Step 2: Write the amount paid
5
Write the amount you are paying for your share of funding for the Energy Efficiency Program.
$__________________________
6
Make your remittance payable to “Illinois Department of Revenue.”
Mail your payment to:
ENERGY EFFICIENCY PROGRAM
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
This form is authorized by the Renewable Energy, Energy Efficiency, and Coal Resources Development Law of 1997. Disclosure of this information
RPU-10 front (N-5/98)
is REQUIRED. Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3833
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