New Hampshire Electric Co-op, Inc.
579 Tenney Mountain Highway
Plymouth, NH 03264
www.nhec.coop
1-800-698-2007
Group Host Annual Report
This form is due April 1 to NH Electric Co-op. NHEC will stop making monthly payments if this
form is not submitted on-time.
This report pertains to calendar year: _________ Group Host Electric Account Number: ________________
HOST INFORMATION – Please update any fields below that have changed in the past year.
Host’s Name & Trade Name:
Host’s Electric Account Number:
Host’s Mailing Address:
Host’s Service Address:
Hosts Telephone Number:
Host’s Email Address:
PERSON RESPONSIBLE FOR RESPONDING TO NHEC INQUIRIES - Please update any fields below that have
changed in the past year.
Name:
Telephone Number:
Email Address:
GROUP MEMBER INFORMATION (Attach additional sheets if necessary) – Please provide any changes in
the information pertaining to current group members below:
Name:
Account Number:
Service Address:
Billing Address:
Projected Annual Load:
Actual Annual Load:
Name:
Account Number:
Service Address:
Billing Address:
Projected Annual Load:
Actual Annual Load:
Name:
Account Number:
Service Address:
Billing Address:
Projected Annual Load:
Actual Annual Load:
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Group Host Annual Report 12/2015
For any member(s) who LEFT the group during the calendar year covered by this annual report, please provide the
following information for each member:
Name:
Separation Effective Date:
Account Number:
Service Address:
Billing Address:
Name:
Separation Effective Date:
Account Number:
Service Address:
Billing Address:
Name:
Separation Effective Date:
Account Number:
Service Address:
Billing Address:
For any member(s) who JOINED the group during the calendar year covered by this annual report, please provide the
following information for each new member:
Name:
Joining Effective Date:
Account Number:
Service Address:
Billing Address:
Actual Annual Load for Calendar Year:
Projected Annual Load:
Name:
Joining Effective Date:
Account Number:
Service Address:
Billing Address:
Actual Annual Load for Calendar Year:
Projected Annual Load:
Name:
Joining Effective Date:
Account Number:
Service Address:
Billing Address:
Actual Annual Load for Calendar Year:
Projected Annual Load
Group Host Annual Report 12/2015
2
Host Data:
Host’s Actual Annual Load for Calendar Year:
Host’s Actual Output for the Calendar Year:
Actual Annual Load (combined) of all Members for the Calendar Year:
Describe any substantial change in the host’s facility:
By signing below, I certify the following:
1. Each member and the host are current default service members of NHEC and do not purchase
power from a third party provider.
2. Each member has signed an agreement that complies with NHEC’s Terms and Conditions which
can be viewed here: T&C Section X - Net Metering
3. I have the authority to sign this report on behalf of the host.
4. The information on this report is true to the best of my knowledge and belief.
Signature:
Printed Name:
Date:
Additional Information:
1. This document may be signed electronically according to RSA 294-A.
2. This report is due April 1, to file via electronic mail please submit to the following addresses:
a. [email protected]
3. To file via U.S. mail please submit to:
NH Electric Co-op
579 Tenney Mountain Highway
Plymouth, NH 03264
Attn: Scott McNeil
4. For questions or inquiries please contact Scott McNeil at 603-536-8608 or [email protected]
For Internal Use Only:
Received by:
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Date Received:
Group Host Annual Report 12/2015