RPNH Enrollment Form-Partners

Channel Partner

New Hampshire Retail Association

Property Type*

Home Apartment Business Other

Are you on an Assistance Program with your utility? *

No Yes

You have selected yes to the previous question.

Although we offer great rate plans, the savings you currently receive most likely outweigh the benefits we may offer you. We would love to have you as a Resident Power customer, however it would be in your best interest to stay with your current plan. We strongly recommend that you do not continue filling out this form.

Continue at your own discretion

Name*

First Name

Last Name

Company Name*

Doing Business As*

Service Address *

Service Address Line 2

Service City*

Service State *

Service Zip code *

Email*

Phone*

Is Billing Address Different?

No Yes

Billing Address *

Billing Address Line 2

Billing City*

Billing State*

Billing Zip Code*

Would you like to specify meters? (Not Typical)

No Yes

Meter Number 1 (Service Reference #)

Meter Number 2 (Service Reference #)

Meter Number 3 (Service Reference #)

Meter Number 4 (Service Reference #)

Need Help finding your account number, name key or billing cycle?

Click here for help reading your bill.

Account Number*

Account Numbers are 10 to 11 digits long, and can be found on the top of your bill

Current Utility*

Customer Name Key*

Usually listed on the right side of bill, typically the first four digits of your last name

Billing Cycle

Listed on the Right Hand Side of Your Bill

Last Four of Social Security

National Grid requires that we collect this information for enrollments. We Promise to Protect Any Personal Information You Provide.

How Did You Find Us?*

Industry

Name of Friend

Sales Reps

Municipality

Partners

Choose One

$0.0899 per kWh - Fixed Term Ends December 2017 $0.0979 per kWh- Fixed 18 month Term

Contract Term

Please Confirm Your PSNH Fixed Rate

Please Confirm your PSNH Flex rate

$0.0yy kWh

Do You Frequent Big Apple Food Stores?

Yes No

Do You Use Any of These Products?

Heating Oil K-1 Propone

Referring Partner

Required: Terms and Conditions

I agree to the above Terms & Conditions

Internal Use Only: CSR

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