Agripower

PROJECT QUESTIONNAIRE


The basic information provided by you in this questionnaire is intended to permit AgriPower to make an initial recommendation to you about whether or not our Systems are suitable for your project and enable us to promptly assist you to the maximum extent possible. Please provide us with the information that you believe will help us in understanding and evaluating your project and making this recommendation. All such information is and will remain confidential. Please try to answer all questions (and please attach additional sheets as necessary). If you require assistance or additional information, please contact us at the telephone numbers and e-mail address below. Please return this form via e-mail or fax as set forth below. We will respond to you within two business days of receipt. Thank you.

OUR QUESTIONS                                YOUR ANSWERS

YOUR PROJECT
Is your project On-Grid or Off-Grid?           $Project_Type$
Please briefly describe your project.
$Project_Description$

YOUR FUEL
Please specify the material(s) you have available that can be used as fuel?      $Fuel_Material$
How many tons of this material is available as fuel on a monthly basis?             $Fuel_Quantity$
Do you generate or have access to this material or do you have to buy it?         $Fuel_Accessibility$
If you generate this material, how is it currently disposed of?                             $Fuel_Disposability$
If you dispose of it, how much is the disposal cost per ton?                                $Fuel_DisposalCost$
If you have to buy it, how much will it cost per ton delivered to your site?          $Fuel_PurchaseCost$
Will you be paid to accept this material and if so, how much per ton?                 $Material_AcceptanceCost$
What is the moisture content of this material?                                                    $Fuel_MoistureContent$
What is the BTU content per pound of this material?                                           $BTU_Content$
Does this material contain any known hazardous substances or other pollutants? $Fuel_ContainsHazardous$
If you use diesel fuel oil to produce power, how many gallons do you purchase every month and at what cost per gallon? $Fuel_Amount_Cost$

YOUR ELECTRICAL REQUIREMENTS
How many total kWh do you require each month?                                 $Electric_KWH$
What is the maximum and minimum number of kW you require hourly? $Electric_consumption_Hourly$
What do you currently pay per kWh (including delivery costs and all taxes)? $Electric_Cost$

YOUR HEAT ENERGY REQUIREMENTS
Can you use heat energy in your project (for heating or drying purposes, or for hot water, steam, air conditioning, refrigeration or water purification)? $Use_Heatenergy$
How much heat do you require per 24 hours (MMBTU/hr)?                           $HeatEnergy_RequiresPerday$
What is the maximum and minimum number of MMBTU you require hourly? $HeatEnergy_RequiresPerHours$
What do you currently pay per MMBTU/hr?                                                   $HeatEnergy_Rate$

MISCELLANEOUS
Is there any additional information about your project we should know about? $Project_AdditionalInfo$
Is this your project or are you acting on behalf of a client?                                 $Project_Client$

YOUR COMPANY INFORMATION

Company Name:                            $Company_Name$
Street Address:                             $Company_StreetAddress$
City, State, Country, Postal Code: $Company_CityState$
Main Telephone   $Company_MainTelephone_number$   Fax Number $Company_Fax$ Website: $Company_website$
Company's Primary Business: $Company_Business$   Year Established: $Company_Eastablished$    Geographic Area(s) Active In: $Company_Area$

PLEASE INDICATE IF YOUR NEED IS IMMEDIATE AND IF YOU WOULD LIKE US TO CONTACT YOU IMMEDIATELY $ImmediateContact$
Name and Title of Person Completing this Project Questionnaire: $Name_contactperson$
Date $Date$   E-Mail Address $Email$   Business Telephone $Business_Phone$  Mobile Phone $Mob_Telephone$


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