Vermont Energy Efficiency Utility Fund Form (Page 4 of 8) in pdf

Vermont Energy Efficiency Utility Fund Form Page 4

VERMONT ENERGY EFFICIENCY UTILITY FUND

Section 4 - Certification

Line 4 - Officer Name Information

Enter the date, officer name, officer signature, and officer title. The officer’s signature attests to

the accuracy of all information on the remittance worksheet.

Line 5 - Contact Name Information

Enter the date, preparer name, preparer signature and preparer title. This person should be

able to provide worksheet clarification and serve as the first point of contact for the VEEUF

Fiscal Agent.

Line 6 – Preparer Complete Mailing Address

Enter the preparer’s complete mailing address, including street address, PO Box number, suite

number, city, state, and zip code. This will serve as the address where all future

correspondence and statement will be mailed.

Line 7 - Preparer Telephone, Fax, and E-Mail

Enter the preparer’s telephone number, fax number and e-mail address.

Worksheet Submission and Payment Method

In the bottom left margin, please take note of submission addresses.

Please see Attachment C - “VEEU Fund Payment and Worksheet Submission Information” for

additional details on submitting payments to the VEEU Fund.

01/2003

Page 4 of 8

Vermont Energy Efficiency Utility Fund Form Page 4