Intake Form

Company Name

Client Name

Contact Email

Contact Phone

Street Address

City

State

Zipcode

Please select your utility provider Please select your utility provider

If Other Please Specify

Billing Name

Billing Address

Billing Contact

Account Number

Sales Representative

Do you give Leyland Energy authorization to access historical data?

Yes

I hereby authorize Leyland Energy LLC, Arc Trade Inc., their affiliates, contractors, and assignees to access all historical data.

Please upload 24 months of historical data

Required upload size: 1MB - 10MB

Please note that when we mention "Leyland Energy," we are referring to ourselves, our affiliates, contractors, and assigns.