Emergency Backup Generator DER Connection Form
Applicant Information
Name
Company
Email
Phone Number
Address
Facility Information
Facility Name
Facility Address
Utility Account Number
Generator Information
Generator Make
Generator Model
Capacity (kW)
Type
Diesel
Natural Gas
Other
Fuel Storage Capacity
Automatic Transfer Switch
Yes
No
Connection & Operation
Interconnection Type
Temporary
Permanent
Operates in Parallel with Utility?
Yes
No
Description of Operation
Supporting Documents
Attach Schematics / Supporting Documents
Additional Comments