OMB Control No. 2060-0347

Attachment to Partnership Letter

Organization Information

	Chief Executive				Energy Manager

	Name & Title:	_______________________	Name & Title:
_______________________

	Mailing Address:	_______________________	Mailing Address:
_______________________

			_______________________			_______________________

_______________________			_______________________ 

	E-mail Address:	_______________________	E-mail Address:
_______________________

	Phone Number:	_______________________	Phone Number:
_______________________

	Facsimile:	_______________________	Facsimile:	_______________________

	Communications Contact

	Name & Title:	_______________________

	Mailing Address:	_______________________ 	

			_______________________				

			_______________________		

	E-mail Address:	_______________________	

	Phone Number:	_______________________ 	

	Facsimile:	_______________________

Organization’s Primary Business or Function (check one):

□	Commercial Real Estate

	□	Corporate Real Estate

	□	Multifamily Housing, include:

				_____ Number of units owned/managed 

□	K-12 Education

□	Higher Education

	□	State Government

		□	Local Government

		□	Federal Government

		□	Healthcare & Senior Care Facilities

	□	Hospitality & Entertainment

	□	Manufacturing/Industrial, include:

				_____ NAICS code

				_____ Number of Manufacturing Plants Operated in the United States 

				_____ Number of Employees in the United States 

	□	Religious (Congregations)

		□	Retail

	□	Drinking Water Treatment and Distribution, include:

_____ Total Capacity (mgd) 

	□	Wastewater Treatment, include:

_____ Total Capacity (mgd) 

	□	Other.  Describe:	_____________________________________

	Organization’s total building/facility square footage (required):

		Owns		_____________________________________

		Leases		_____________________________________

		Manages 	_____________________________________	

	How did you learn about Energy Star? 

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The public reporting burden for this collection of information is
estimated to average 30 minutes per response.  Send comments on the
Agency's need for this information, the accuracy of the provided burden
estimates, and any suggested methods for minimizing respondent burden,
including through the use of automated collection techniques to the
Director, Collection Strategies Division, U.S. Environmental Protection
Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. 
Include the OMB control number in any correspondence.  Do not send the
completed form to this address.

EPA Form 5900-19

