Carson City:
1150 E. William Street
Carson City, NV 89701-3109
(775) 684-6101
Fax (775) 684-6110
Las Vegas:
9075 West Diablo Drive, Suite 250
Las Vegas, NV 89148
(702) 486-7210
Fax (702) 486-7206

Universal Energy Charge Form
This form is applicable to (a) quarterly payments and (b) prepayments by retail customers pursuant to NAC 702.370.

CPC or CMRS #:  
Company Name:  
Company Address1:  
Company Address2:  
Company City:   State:  Zip:      
Company Telephone:  
Type of Utility:  

Preparer First Name:    Last Name:      
Confirmation Email:  

Preparer Company:    
Preparer Address1:    
Preparer Address2:  
Preparer City:  State:  Zip:      
Preparer Telephone:    
UEC Payer Type:
Select Payment Type:
For the the quarter ending: Year:

Payment Amount: