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 #: AlphanumOnly Company Name: Required AlphanumOnly No , Company Address1: Required AlphanumOnly No , Company Address2: AlphanumOnly No , Company City:   State: Nevada Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming  Zip: CityRequired StateRequired ZipRequired Company Telephone: Required Invaild Format Type of Utility: Electric / GAS * Preparer First Name:  * Last Name: * AlphanumOnly No , AlphanumOnly No , Confirmation Email: Invalid Format Required   Use Company Address Information Above   Preparer Company: AlphanumOnly Required Preparer Address1: AlphanumOnly No , Required Preparer Address2: AlphanumOnly No , Preparer City:  State: Nevada Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming  Zip: CityRequired StateRequired ZipRequired Preparer Telephone: TelephoneRequired Invaild Format UEC Payer Type: Municipal Utility Public Utility Retail Customer Select Payment Type: Quarterly Payment Prepayment For the the quarter ending: March 31 June 30 Sept 30 Dec 31 Year:   Payment Amount: Required Numeric only