I would like to participate in the NC GreenPower program. I understand this is a voluntary program. Haywood EMC
will remit all contributions to the NC GreenPower organization. Refunds, pro-rations, or partial billing are not
permitted under this agreement. If payment of the contribution is not made for two consecutive months I will be
removed from the program. I can terminate my participation at any time by calling Haywood EMC and requesting
to be removed.

I wish to contribute block(s) at a cost of $4.00 per block. My total contribution per month will be will be
$ . My contribution will be on my bill beginning with the (month) bill.