Ill. Admin. Code tit. 83, pt. 512, subpt. D, app A
UNIFORM DISCLOSURE STATEMENT
Name:
Business Address:
Internet Address:
Phone and hours of operation:
This is a sales solicitation and the seller is (insert AGS name), an alternative gas supplier. If you enter into a contract with the seller, (insert AGS name) will be your gas supplier. The seller is not endorsed by, representing, or acting on behalf of, a utility or a utility program, a consumer group or consumer group program, unless the AGS is, through the consumer group, offering services at prices, terms and conditions that are available solely to members of that organization, or a governmental body or program of a governmental body.
If you have any questions or concerns about this sales solicitation, you may contact the Illinois Commerce Commission's Consumer Services Division at 800-524-0795.
Date:_____________________Agent Name ID:_____________________
Ill. Admin. Code tit. 83, pt. 512, subpt. D, app A