Sign Up Confirmation – ElectricChoice.com

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Plan Name:

Rate Type:

Variable

Term:

months

Early Cancellation Fee:

$ 0

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Please review your order for accuracy and submit it at the bottom of this page.

First Name :

Last Name :

Phone :

Email Address :

Social Security :

Driving License No. :

Date of Birth :

01/01/1970

Dwelling Type :

Request Type :

Requested Turn On Date :

Utility Account Number / ESI ID :

SERVICE ADDRESS

Street :

City :

State :

Zip Code :

MAILING ADDRESS

Street :

City :

State :

Zip Code :

First Name :

Last Name :

Phone :

Email Address :

Date of Birth :

Utility Account Number / ESI ID :

SERVICE ADDRESS

Street :

City :

State :

Zip Code :

MAILING ADDRESS

Street :

City :

State :

Zip Code :

Please check the errors below:

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Authorization & Verification of Terms & Conditions

I am legally authorized to enter into an agreement for electricity service with for the location listed above, and have read the Electricity Facts Label.
You authorize to perform a credit check to determine if a deposit is required.
If you are switching REPs, you have the right to review and rescind the TOS without penalty within three federal business days of receiving the mailed TOS, which you shall be receiving in approximately 4 to 7 days. You may exercise this right by contacting at:

I affirm that I understand and agree to the statements listed above.

By checking this box, you affirm that you wish to change from your current REP to and that you designate to perform the tasks necessary to complete a switch or move-in for your service with .

If you experience a service outage any time during your agreement, please contact your TDU.

Would you prefer correspondence from to be in English or Spanish?

English Spanish

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Don’t hesitate to give us a call!
We’re available from 8:00 AM – 5:00 PM every Monday – Friday.

1-800-974-3020

FINAL STEP: Please review your order for accuracy and submit it at the bottom of this page.

First Name:

Last Name:

Phone:

Email Address:

Date of Birth: 01/01/1970

Dwelling type:

Request Type:

Requested Turn On Date:

Utility Account Number / ESI ID :

Service Address

Street:

City:

State:

Zip Code:

Mailing Address

Street:

City:

State:

Zip Code:

First Name:

Last Name:

Phone:

Email Address:

Date of Birth:

Dwelling type:

Request Type:

Utility Account Number / ESI ID :

Service Address

Street:

City:

State:

Zip Code:

Mailing Address

Street:

City:

State:

Zip Code:

Authorization & Verification of Terms & Conditions

I am legally authorized to enter into an agreement for electricity service with for the location listed above, and have read the Electricity Facts Label.
You authorize to perform a credit check to determine if a deposit is required.
If you are switching REPs, you have the right to review and rescind the TOS without penalty within three federal business days of receiving the mailed TOS, which you shall be receiving in approximately 4 to 7 days. You may exercise this right by contacting at:

I affirm that I understand and agree to the statements listed above.

By checking this box, you affirm that you wish to change from your current REP to and that you designate to perform the tasks necessary to complete a switch or move-in for your service with .

If you experience a service outage any time during your agreement, please contact your TDU.

Would you prefer correspondence from to be in English or Spanish?

English Spanish

Please wait…

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Authorization & Verification of Terms & Conditions