FormAggregratorBrokerConsultant

How are you interested in partnering with Constellation?

I am a(n) ... Check that apply: *

Aggregator / Broker / Consultant

Association / Chamber

National & Regional Brand

Door to Door Vendor

Strategic Alliance / Referral Partner

How are you interested in working with Constellation retail business?

I am a(n) ... Check all that apply: *

Aggregator

Broker

Consultant

Contact information

First Name *

Last Name *

Title

Company/Organization *

Email Address *

Phone Number *

Street Address *

City *

Zip Code *

State *

How many years has your company/organization been in business? *

What products/services are you interested in? *

Electricity

Natural Gas

Renewable Energy

Energy Efficiency

Solar

Load Response

Are the products/services that you are interested in for business or residential customers? *

What products and/or services does your company provide?

What suppliers does your company currently work with?

How would you describe your customer base? Do you target any specific verticals or customer types?

How large is your member/customer base? *

Please fill mandatory values under "Average size of customer" section.
+ Average size of the customer

Electricity (Annual MWhs) *

Gas (Therms) *

Other

What states are you currently active in? *

In the states mentioned above, which ones do you have a license? *

Does your business mainly focus on the energy sector or would this be an ancillary sale to your core business?

+ Describe your sales force

+ Consent Form

Company Contact Information

Company name

Address

City

Zip Code

State

Telephone Number

Website (if applicable)

State of Incorporation

Owners/Officers:

(Include Full Name and Title of top three officers with contact phone number and email address)

Primary Contact

Name

Phone Number

Email Address

Secondary Contact

Name

Phone Number

Email Address

Additional Contact

Name

Phone Number

Email Address

List Corporate Parent/Affiliate Companies:

General Company Information

Please list any state(s) currently doing business

Is this entity/corporation registered and in good standing with the state(s) in which it conducts business?

Is this entity/corporation properly licensed, if a license is required in the state(s) in which it conducts business?

Please provide the license number(s) and the state(s) it applies to

Has this entity/corporation or any of its principals ever filed for bankruptcy? If yes, when and what were the circumstances?

Are there any tax liens, judgments, law suits or other legal actions currently outstanding against the entity/corporation or any of its principals?

Have any of the principals ever been convicted of a crime other than a minor traffic offense? If yes, please explain

Is this company or any of its principals currently or ever been under investigation by any regulatory agency, including, but not limited to Federal Energy Regulatory Commission (FERC) the Commodities Futures Trade Commission (CFTC) or the Securities and Exchange Commission (SEC)? If yes, please explain.

Please provide a brief summary of the entity's and the principal's experience in the electricity business

How are you interested in partnering with Constellation?

How are you interested in working with Constellation retail business?

Contact information

Please fill mandatory values under "Average size of customer" section. + Average size of the customer

+ Describe your sales force

+ Consent Form

(Include Full Name and Title of top three officers with contact phone number and email address)

Submit CLEAR

Please fill mandatory values under "Average size of customer" section.
+ Average size of the customer

CLEAR