GUAM POWER AUTHORITY

INTERNAL AUDIT - REVENUE PROTECTION SECTION (IA-RPS)

Tel: (671) 648-3090 through 3094

Fax: (671) 648-3163

Email Address: ia_rps@guampowerauthority.com

ENERGY THEFT REPORT FORM

Please fill out the following information and press the "SUBMIT" button:

Date:

Reported By (OPTIONAL):

Home Contact No. (OPTIONAL):

Work Contact No. (OPTIONAL):

Fax No. (OPTIONAL):

Email Address (OPTIONAL):

Situation: (Describe nature of alleged tampering activity. Please be as specific and descriptive as possible.)

Location:

Address:

Name of Perpetrator(s) (If known):

When you press the "SUBMIT" button, you are authorizing GPA IA-RPS, and any agency GPA sees fit to provide this information to, permission to use the information provided in whatever manner is appropriate and/or required. You also release all claims to the information, and the results of the use thereof. GPA IA-RPS in no way accepts any responsibility regarding the information provided.

Date:
Reported By (OPTIONAL):
Home Contact No. (OPTIONAL):
Work Contact No. (OPTIONAL):
Fax No. (OPTIONAL):
Email Address (OPTIONAL):
Situation: (Describe nature of alleged tampering activity. Please be as specific and descriptive as possible.)
Location:
Address:
Name of Perpetrator(s) (If known):
When you press the "SUBMIT" button, you are authorizing GPA IA-RPS, and any agency GPA sees fit to provide this information to, permission to use the information provided in whatever manner is appropriate and/or required. You also release all claims to the information, and the results of the use thereof. GPA IA-RPS in no way accepts any responsibility regarding the information provided.