Electricity Sign-Up Form

Fields marked with * are required fields.

*Name:
(first)

(last)
*Email:
*I'm a:  Resident Business
*Street Address: *Zip: 
*Home or Business Phone:
Please enter digits only (ex. 2037440600)
Marketing Code:
*Utility Company:
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*Utility Account Number:
*Verify Account Number:
Please enter twice for verification (- Do not copy and paste - )
*4-Letter Customer Name Key:
*Verify Name Key:
Please enter your name key twice for verification (- Do not copy and paste - )
*Rate Plan:
*E Signature:
I agree to the terms and conditions.
Enter the security code in the text box below:
     captcha

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