Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
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
Account ID
2
4
____________________________________________________
License no.: E- ___ ___ ___ ___ ___
Number and street
5
____________________________________________________
(_____)_______________________
City
State
ZIP
Daytime telephone number
Step 2: Write the amount paid
6
Write the amount you are paying for your share of funding for the Energy Efficiency Program.
$__________________________
7
Make your remittance payable to “Illinois Department of Revenue.”
Mail your payment to:
ENERGY EFFICIENCY PROGRAM
*041001110*
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
RPU-10 front (R-04/10)
This form is authorized by the Renewable Energy, Energy Efficiency, and Coal Resources Development Law of 1997. Disclosure of this information 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
3
1
___ ___ ___ ___ ___ ___ ___ ___
____________________________________________________
Account ID
Name
4
2
License no.: E- ___ ___ ___ ___ ___
____________________________________________________
Number and street
5
(_____)_______________________
____________________________________________________
Daytime telephone number
City
State
ZIP
Step 2: Write the amount paid
6
Write the amount you are paying for your share of funding for the Energy Efficiency Program.
$__________________________
7
Make your remittance payable to “Illinois Department of Revenue.”
Mail your payment to:
ENERGY EFFICIENCY PROGRAM
*041001110*
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
RPU-10 front (R-04/10)
This form is authorized by the Renewable Energy, Energy Efficiency, and Coal Resources Development Law of 1997. Disclosure of this information is
REQUIRED. Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3833
Reset
Print