Operation Round-Up Program Authorization Form

Please Choose Only One

Yes, I would like to participate in the Operation Round-Up Program. I wish to have my monthly electric bill rounded up to the next highest dollar.

Yes, I would like to participate in the Operation Round-Up Program. I wish to contribute the amount indicated below per month to the Operation Round-Up Program and this amount will be added to my monthly electric bill.

Monthly Contribution

Name

Address

City/Town

State/Province

ZIP/Postal Code

Phone number

Consumers Energy Account Number