Mail this completed form, along with the required attachments to the contact person listed at the bottom.

	Company Information:
Company Name:	______________________________________
Address Line 1:	______________________________________
Address Line 2:	______________________________________
Phone Number:	______________________________________

	Contact Person for Credit Information:
Name:	______________________________________
Phone Number:	______________________________________
Fax:	______________________________________

	Parent or Guarantor Company Information: (if applicable)
Company Name:	______________________________________
Address Line 1:	______________________________________
Address Line 2:	______________________________________
Phone Number:	______________________________________

Additional Information

• Please attach your company's latest audited financial statement.
• If your company is a subsidiary and it does not have an audited financial statement, please attach the latest audited financial statement for your parent company or guarantor company. NOTE: When selling power to a subsidiary company that does not have its own financial statement, NPPD requires a written guarantee from the parent company or guarantor company. Please contact the person below for the guarantee form. Please contact the person below for the appropriate forms.
• As an alternative to the above, NPPD will accept Surety Bonds, Letters of Credit, Deposits, etc. Please contact the person below for the appropriate forms.
• NPPD policy requires all credit instruments be governed by and construed in accordance with the laws of Nebraska.

Contact Person:

Douglas M. Blatchford Finance and Risk Management Department Nebraska Public Power District P.O. Box 499, Columbus, NE 68602-0499 Telephone: (402) 563-5571 Fax: (402) 563-5528 E-mail: dmblatc@nppd.com

Revised: 11/3/98