Section 412.APPENDIX A Uniform Disclosure Statement

UNIFORM DISCLOSURE STATEMENT

Name:

Address:

Internet Address:

Phone and hours of operation:

Rates and Product Information
Price (in cents/kWh) and number of months this price stays in effect:
Utility Electric Supply Price to Compare (PTC) (in cents/kWh):	Price:	Effective:		Expires:

(Name of the alternative retail electric supplier) is not the same entity as your electric delivery company. You are not required to enroll with (name of alternative retail electric supplier). Beginning on (effective date), the electric supply price to compare is (price in cents per kilowatt hour). The electric utility electric supply price will expire on (expiration date). The utility electric supply price to compare does not include the purchased electricity adjustment factor. For more information go to the Illinois Commerce Commission’s free website at www.pluginillinois.org. If applicable, the disclosure will also include the following statement: "The purchased electricity adjustment factor may range between +.5 cents and -.5 cents per kilowatt hour."
Other periodic charges:
Total Price (in cents/kWh) with other periodic charges:	500 kWh		1,000 kWh		1,500 kWh

Length of contract:
Price after the initial price:
Contract Renewal

Contract Renewal:
Right to Rescind and Terminate
Rescission:	You have a right to rescind (stop) your enrollment within 10 calendar days after the date on your electric utility's written notice confirming the switch of your supplier. You may call us at (toll-free number) or your utility at (toll-free number) to rescind.
Termination:	You have the right to terminate an agreement with an alternative retail electric supplier AT ANY TIME WITH NO TERMINATION FEES AND NO PENALTIES. You may call us at (insert ARES toll-free number) to terminate this contract. The limit on early termination fees and penalties shall not apply to charges or fees for devices, equipment, or other services provided by the alternative retail electric supplier.

This is a sales solicitation and the seller is (insert ARES Name), an independent retail electric supplier. If you enter into a contract with the seller, (insert ARES name) will be your retail electric supplier. The seller is not endorsed by, representing, or acting on behalf of, a utility or utility program, a consumer group or consumer group program, unless the ARES 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, unless the ARES has entered into a contractual arrangement with the governmental body and has been authorized by the governmental body to make the statements.

If you have any concerns or questions about this sales solicitation, you may contact the Illinois Commerce Commission's Consumer Services Division at 800-524-0795. For information about the price to compare (PTC)of your electric utility and offers from other retail electric suppliers, please visit PlugInIllinois.org.

Date:

Agent Name/ID:

(Source: Amended at 46 Ill. Reg. 19509, effective November 23, 2022)