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:
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:
Company Telephone:
Type of Utility:
Electric / GAS
Preparer First Name:
Last Name:
Confirmation Email:
Use Company Address Information Above
Preparer Company:
Preparer Address1:
Preparer Address2:
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:
Preparer Telephone:
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: