Energy Emergency Contact Form - U.s. Department Of Commerce

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Energy Emergencies and
Security Program
Energy Emergency Contact Form
Utility/Company Name:
Date:
Check:
Street Address:
Electricity
Natural Gas
Phone Numbers
Mailing Address:
General Phone
(If different)
General Fax
Manager:
Name:
Phone:
Email:
EOC
24 hour dispatch
PIO:
Name:
Phone:
Email:
Provide contact information for those we should contact, in order of priority. Please check the Listserv box for those wanting notification emails.
Name
Title
Work Phone
Cell. Phone
Eve. Phone
E-mail
Listserv
1
2
3
4
5
To check check-boxes, double-click on the box, then change the default value to checked and select OK.
Thank you. Please email to
energy_policy@commerce.wa.gov
when complete.

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