Laserfiche WebLink
9199772551 Duke Energy <br />1 I VI{.I- UVYlair way <br />Duke Energy <br />t J IU t 1U • VYU <br />10:00:48 a.m. 05-02-2019 5 )5 <br />UJIUIfGU17 IJ.JU R.71U 1'.UU:JIUUU <br />Signature: <br />The undersigned Energy Provider hereby agrees and warrants to the State of North Carolina and the <br />County Department, that the undersigned will comply with the terms and conditions outlined In this <br />Agreement to receive monies under the Low -Income Home Energy Assistance Program. <br />hereby declare that I have read and understand the above and agree to comply and abide with the <br />terms and conditions specified while participating in the program. <br />Duke Energy Progress <br />P� any N or <br />fir <br />(Si : n . remRany Represen ative) <br />20/ <br />K <br />/(Date') D1 1�' nil if <br />(Pri t Mailing Address) <br />City, State, Zip Zi !ode) <br />56 —olio <br />(Telephone <br />er) <br />(Provider Federal ID Number (FEIN cy SAN) �C � Primary Email Address) <br />Ccvtsl�r--a-PCal13 nI W-e-•tner�z'6 <br />(Primary E-rr it Address) <br />Ire or ame) <br />(S;ature of County recfdr) <br />fec\ <br />(Date) <br />PO Box 1066 <br />(Print Mailing Address) <br />Sanford, NC 27331 <br />(Print City, State, Zip Code) <br />(Telephone Number) <br />DSS -8163 (06/18) <br />Economic and Family Services <br />nc/n9I7n1a no FO <br />RIS, • Door <br />Page 3 of 3 <br />