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<title>Metromedia Energy Form</title>
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<td><img src="mme_banner.jpg" alt="Metromedia Energy" width="770" height="78" border="0"></td>
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<div align="center">
<p><font size="5" face="Arial, Helvetica, sans-serif"><br>
<b>Metromedia Energy, Inc. </b></font></p>
<p><font size="3" face="Arial"><b>Providing Our Commercial and Industrial Customers<br>
with Energy Savings for Over Ten Years</b></font></p>
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<p><font size="2" face="Arial"><br>Please provide us with the following information.<br>
It will allow us to quickly tell you whether we can save you money on your electric bill.
</font></p>
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<form method="POST" action="_vti_bin/shtml.dll/MetromediaMaineNew2.htm" onSubmit="" webbot-action="--WEBBOT-SELF--">
<!--webbot bot="SaveResults" U-File="_private/form_results.csv" S-Format="TEXT/CSV" S-Label-Fields="TRUE" S-Email-Address="[email protected]" S-Email-Format="TEXT/PRE" startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveResults" i-checksum="43374" endspan -->
<table border="0" bgcolor="#ffffaa" width="468" id="table1">
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<td align="center" colspan="2" bgcolor="#6699cc" valign="middle"><b>
<font size="2" face="Arial">CUSTOMER INFORMATION</font></b></td>
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<td align="center" colspan="2" valign="middle"><b>
<font size="1" face="Arial"> </font></b></td>
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<td width="150" height="25" valign="middle">
<font size="2" face="Arial">First Name:</font></td>
<td width="318"><font size="2">
<input type="text" size="30" name="FirstName"><br>
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<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Last Name:</font></td>
<td width="318"><font size="2">
<input type="text" size="30" name="LastName"><br>
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<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Title:</font></td>
<td width="318"><font size="2">
<input type="text" size="30" name="Title"><br>
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<td width="150" height="25" valign="middle">
<font face="Arial" size="2">Organization:</font></td>
<td width="318"><font size="2">
<input type="text" size="30" name="Organization"><br>
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<td width="150" height="25" valign="middle">
<font face="Arial" size="2">Utility:</font></td>
<td width="318"><font size="2">
<input type="text" size="30" name="Utility"><br>
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<td width="150" height="25" valign="middle">
<font face="Arial" size="2">Work Phone:</font></td>
<td width="318"><font size="2">
<input type="text" size="30" name="WorkPhone"><br>
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<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Email:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="Email"><br>
</font></td>
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<td width="468" height="25" valign="middle" colspan="2">
<p align="center"><font SIZE="2" face="Arial"><br>Please click the <b>Submit
Information</b> button below <br>
or you can also submit this form via E-Mail, Fax, Call or Mail
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<td width="150" height="25" valign="middle">
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<td width="318"> </td>
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<p align="right">E-Mail: </td>
<td style="color: blue; text-decoration: underline; text-underline-style: single; font-size: 10.0pt; font-weight: 400; font-style: normal; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px">
<a href="mailto:[email protected]">METROMEDIA ENERGY</a></td>
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<td style="color: blue; text-decoration: none; text-underline-style: single; font-size: 10.0pt; font-weight: 400; font-style: normal; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px"> </td>
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<td style="font-weight: 700; font-family: Arial, sans-serif; color: windowtext; font-size: 10.0pt; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px" align="center">
Fax:</td>
<td style="color: windowtext; font-size: 10.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px">
<font size="2">253-663-7224 </font></td>
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Call:</td>
<td style="color: windowtext; font-size: 10.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px">
732-440-0032</td>
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<font SIZE="2">Mail:</font></td>
<td style="color: windowtext; font-size: 10.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px">
Metromedia Energy</td>
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<td style="color: windowtext; font-size: 10.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px">
6 Industrial Way</td>
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<td style="color: windowtext; font-size: 10.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px">
Eatontown, NJ 07724</td>
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<td style="color: windowtext; font-size: 10.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Arial; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding-left: 1px; padding-right: 1px; padding-top: 1px">
<font SIZE="2">Att: George Lackett</font></td>
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<input type="submit" value="Submit Information" name="B1"><input type="reset" value="Reset Information" name="B2"></p>
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<p> </p>
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