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2. Requestor's Contact Information
4. Business Name
6. Email Address
7. Phone Number
9. First Name
10. Last Name
12. Reason for Application

    1. New Applicaiton
    2. Annual Renewal
16. 24/7 Contact Details
18. First Name
19. Last Name
21. Title
22. Email Address
24. Address
26. City
27. State
28. Zip Code
30. Phone Number
31. Cell Phone Number
33. Email Address
37. Service Address Information
39. Facility Address
41. City
42. State
43. Zip Code
45. Is the Customer/Facility registered with ERCOT as a Load Resource

    1. Yes
    2. No
49. Facility Type and Description
51. Select the applicable services group for this application (one only)

    1. Public Safety (Hospitals, Police Stations, Fire Stations, Critical and Wastewater Facilities, etc.)
    2. Critical Natural Gas Facility
    3. Critical Care Business

    Description of Options:

    Public Safety: A customer for whom electric service is considered crucial for the protection or maintenance of public safety

    Critical Natural Gas Facility: A facility designated as a critical customer by the Railroad Commission of Texas under §3.65(b) of this title (relating to Critical Designation of Natural Gas Infrastructure) unless the facility has obtained an exception from its critical status. Designation as a critical natural gas facility does not guarantee the uninterrupted supply of electricity.

    Critical Care Business: A business customer for whom an interruption or suspension of electric service will create a dangerous or life-threatening condition on the retail customer’s premises.

53. Describe any existing battery or backup capacity or duel feed capability:

    1. None
    2. Battery Backup
    3. Backup Generation
    4. Other
55. Backup Capacity

    Battery backup or backup generation capacity.

57. Length of time the facility can operate without electricity from GEUS:
59. Length of time requires for start-up following a power outage:

61. Click submit or print the completed form and mail to:

    GEUS Compliance and Risk Officer

    6000 Joe Ramsey Blvd

    Greenville, TX 75402

    903-457-2829

Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

* indicates a required field