Residential Second Chance Billing Enrollment

Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Phone*
Email*
Type of Service Order*
- Priority New Service 1 - 4 Hrs
- Self Select Switch - Advance Date Selected
- Standard Switch 3 - 5 Days‎
- Temporary Priority New Service 1 - 4 Hrs‎
Requested Flow Start Date*
Date Format: MM slash DD slash YYYY
Service Address*
Street Address Address Line 2 City State ZIP Code
Energy Rate and Term*
How Did You Hear About Us?
Terms of Enrollment*
- I have read and understand all of the authorization disclosures and terms of service. I am at least 18 years of age and legally authorized to buy electricity for the address above.‎
- I confirm my enrollment for service with N.D.C.A. / Pronto Power and have read, understand, agree to the "Terms of Service" and "Your Rights as a Customer", Electricity Facts Label documents and other disclosures relating to my enrollment for service. * I designate N.D.C.A. / Pronto Power to complete the necessary tasks to become my electric service from my current REP to Pronto Power. You will receive a copy of these documents via email and US mail, that will explain all the terms of the agreement and how to exercise the right of rescission, if applicable. You can further request a copy to be sent via US mail at any time.‎
- I Agree to Enroll for N.D.C.A. of North America Aggregator Services.‎
- I Understand the Free $100.00 credit processes to the account in 10 installments 1 every 30 days.‎
- I Understand to qualify for monthly billing without a deposit I must not have any Disconnections in a 4 month period.‎
Digital signature*
Email
This field is for validation purposes and should be left unchanged.

Residential Second Chance Billing Enrollment

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