North Carolina - Energy Efficiency Rider Opt Out Form
Instructions for Opt Out Application Request
This form is to notify Duke Energy of your decision, pursuant to N.C.G.S. 62-133.9(f) and North Carolina
Utilities Commission (NCUC) Rule R8-69(d), to not participate in Duke Energy’s energy efficiency and/or
demand-side management programs. By opting out, the applicable cost recovery factor(s) of Rider EE will not
be charged for each qualifying agreement. The undersigned hereby certifies that, at your own expense, your
have already implemented, or will be implementing, alternative energy efficiency measures, in accordance with
stated, quantifiable goals.
Please include the name of the person in your company who has the authority to execute contracts
(individual who will be submitting this filing to Duke Energy).
Company Name
Contact Person
Title
Mailing Address
City
State
Zip Code
Phone Number
Email Address
List the Duke Energy accounts you wish to be excluded from charges associated with Duke Energy’s
energy efficiency and/or demand-side management programs. Only agreements for industrial service
and commercial service using 1 million kilowatt-hours annually are eligible to opt out. If multiple
agreements are on a single account, each agreement must meet the opt out criteria.
Account/
Agreement
Number(s)
Ex: 1234567890
Facility Address
555 Anywhere Street, Charlotte, NC 12345
Opt Out of
Energy Efficiency
Opt Out of
Energy
Efficiency
Previously
Received
Incentive
Opt Out of
Demand-Side
Management
x
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If needed, please use a separate document to list additional accounts and attach to this form.
I hereby certify and attest that the establishment for each agreement identified above has gone through
an energy audit or analysis, and has implemented, or plans to implement, energy efficiency measures
recommended in that audit or analysis.
I understand Duke Energy may be required to inform the NCUC of our decision to opt out and
understand that our election decision could become public record.
I understand that the decision to opt out of energy efficiency programs and demand side management
programs may be changed on an annual basis. I also understand that if I elect to participate in a
demand side management program by committing load at my facility for interruption, as a part of the
program, that I am obligated to fulfill my required contract terms before opting out.
Name
Signature
Date
This form should be completed and returned prior to Dec. 31. Requests postmarked after Dec. 31, 2011,
cannot be accepted and you must wait until the next annual election window (Nov. 1 to Dec. 31, 2012)
to submit your request.
Please send to Duke Energy’s Business Service Center via:



Mail: Duke Energy, Mail Code EC2ZA, 526 South Church Street, Charlotte, NC 28202-1904
Fax: 1-800-510-7347
Email: businessservicecenter@duke-energy.com
To email, save the form to a hard drive, fill in the required information, then send it to the email address above
as an attachment.
A new customer who is eligible has a 60-day window from meter set to make an enrollment decision.
Once your account has been adjusted as requested, we will send an email confirmation to the maker of this
request.
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