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THIS IS NOT AN AGREEMENT TO PROVIDE SERVICES.  IF COMPANY AGREES TO PROVIDE SERVICES TO YOU, SERVICES WILL BE PROVIDED PURSUANT TO AN AGREEMENT FOR SERVICES THAT YOU WILL BE REQUIRED TO SIGN AND OF WHICH THIS APPLICATION WILL BECOME A PART. NO INFORMATION PROVIDED BY APPLICANT WILL BE SOLD TO ANY THIRD PARTIES.

PRICES LISTED ON THIS APPLICATION, INCLUDING UNDER THE HEADING “TOTAL CHARGES”, AND IN ALL OTHER COMPANY MATERIALS DO NOT INCLUDE TAXES, REGULATORY CHARGES, REGULATORY COST RECOVERY CHARGES, SURCHARGES OR FRANCHISE FEES. BILLS ISSUED BY COMPANY WILL INCLUDE APPLICABLE TAXES, REGULATORY CHARGES, REGULATORY COST RECOVERY CHARGES, SURCHARGES AND FRANCHISE FEES. PRICES ARE THE INITIAL PRICES THAT WILL BE CHARGED, BUT MAY BE INCREASED AS PROVIDED IN YOUR AGREEMENT FOR SERVICES WITH COMPANY.

Is this application for a business? *
Your date of birth?
Will there be a co-applicant on this account? *
Do you own or rent your home?
Is your mailing address different than your service address? *
How would you like to receive your monthly bill? *

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