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Agent Form
Agent Enrollment Form – BETA
Please complete the enrollment form with the customer on the phone.
1
ENROLLMENT
2
DISCLOSURE
AGENT ID
Agent ID
(Required)
Agency ID
Hidden
Hidden Spacer
Hidden
Hidden Spacer
RATES
Product Plan
(Required)
Centerpoint 12
- RANCHERO PRIME 12
Centerpoint 24
- RANCHERO PRIME 24
Oncor 12
- RANCHERO PRIME 12
Oncor 24
- RANCHERO PRIME 24
AEP Central 12
- RANCHERO PRIME 12
AEP Central 24
- RANCHERO PRIME 24
AEP North 12
- RANCHERO PRIME 12
AEP North 24
- RANCHERO PRIME 24
TNMP 12
- RANCHERO PRIME 12
TNMP 24
- RANCHERO PRIME 24
Hidden
Utility
CenterPoint
Oncor
AEP Central
AEP North
TNMP
FIXED RATE - 6
Price Per kWh
$0.071
6 MONTH TERM
Lock-in this great rate for 6 months and enjoy price stability.
Stability Price For 6 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed Plan)
Get Started >>
FIXED RATE - 12
Price Per kWh
$0.056
12 MONTH TERM
Lock-in this great rate for 12 months and enjoy price stability.
Stability Price For 12 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed Plan)
Get Started >>
FIXED RATE - 24
Price Per kWh
$0.031
24 MONTH TERM
Lock-in this great rate for 24 months and enjoy price stability.
Stability Price For 24 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed Plan)
Get Started >>
Average Monthly Usage
500 kWh
1000 kWh
1500 kWh
2000 kWh
Average Price Per kWh
12.3 cents
11.4 cents
11.1 cents
10.9 cents
Fixed / Variable
Fixed
Energy Charge
$ 0.070833
Term Length
12 Months
TDU Delivery
$0.036789
Cancel Fee
$ 249
TDU Monthly Charge
$ 4.39
Monthly Charge
$ 4.59
This Product's Renewable content
6%
Taxes
1% to 2%
Average Monthly Usage
500 kWh
1000 kWh
1500 kWh
2000 kWh
Average Price Per kWh
12.3 cents
11.4 cents
11.1 cents
10.9 cents
Fixed / Variable
Fixed
Energy Charge
$ 0.070833
Term Length
12 Months
TDU Delivery
$0.036789
Cancel Fee
$ 249
TDU Monthly Charge
$ 4.39
Monthly Charge
$ 4.59
This Product's Renewable content
6%
Taxes
1% to 2%
ESTIMATED USAGE - 500 kWh
Price Per 500 kWh
10.5 ¢
12 MONTH TERM
Lock-in this great rate for 12 months and enjoy price stability.
Stability Price For 12 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed P
Get Started >>
ESTIMATED USAGE - 1000 kWh
Price Per 1000 kWh
10.1 ¢
12 MONTH TERM
Lock-in this great rate for 12 months and enjoy price stability.
Stability Price For 12 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed P
Get Started >>
ESTIMATED USAGE - 2000 kWh
Price Per 2000 kWh
10.2 ¢
12 MONTH TERM
Lock-in this great rate for 12 months and enjoy price stability.
Stability Price For 12 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed P
Get Started >>
FIXED RATE - 6
Price Per kWh
$0.487
6 MONTH TERM
Lock-in this great rate for 6 months and enjoy price stability.
Stability Price For 6 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed Plan)
Get Started >>
FIXED RATE - 12
Price Per kWh
$0.0789
12 MONTH TERM
Lock-in this great rate for 12 months and enjoy price stability.
Stability Price For 12 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed Plan)
Get Started >>
FIXED RATE - 24
Price Per kWh
$0.0695
24 MONTH TERM
Lock-in this great rate for 24 months and enjoy price stability.
Stability Price For 24 Months
NO Deposit Required
Low Monthly Service Fee
In-House Customer Service
Terms of Service (Fixed Plan)
Get Started >>
ACCOUNT INFO
ESI-ID
(Required)
Optional (if the customer has their bill). This is a 17 or 22 digit number that identifies their meter and is found on the Electric Bill.
CONTACT NAME
Billing Name
(Required)
First
Middle
Last
Relationship To Account Holder
(Required)
Account Holder
Spouse
Son / Daughter over 18 Years Old
Authorized Name
(Required)
First
Last
Date of Birth (Account Holder)
(Required)
Month
1
2
3
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12
Day
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Year
2025
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CONTACT INFO
Primary Phone Number
(Required)
Phone Type
(Required)
Mobile
Home
Alternative Phone Number
Phone Type (Alternative)
Mobile
Home
Other
Email (Account Holder)
(Required)
Enter Email
Confirm Email
Notifications
I want to receive promotional information about products and services via text message.
Notifications will be sent via automated text message. Message and data rates may apply.
Add A Secondary Account Holder
YES
Name (Secondary Holder)
First
Middle
Last
Date of Birth (Secondary Holder)
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
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29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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2002
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1921
1920
What Language would you like us to use for future communications?
English
Spanish
Your Service Information
Service Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Reason for Enrollment
(Required)
Move-in
Switch
Requested Service Start Date (No Weekends / No Holidays)
(Required)
MM slash DD slash YYYY
Minimum (10 Business Days) - Maximum (120 Business Days). Exclude Weekends and Holidays.
Billing Information
Billing Information Is Different
My billing address is DIFFERENT than my Service Address
Billing Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Method Of Billing
(Required)
Paper Billing Only
Electronic Billing Only
Both Paper and Electronic Billing
FORM DISPOSITION
Disposition
Abandon
Submit
Customer Info
This conversation is being recorded for verification purposes.
I am creating your account today,
[current_date]
To ensure the accuracy of the information we have discussed, can you please speak clearly and state your
FULL NAME
and
SERVICE ADDRESS
out loud, in-full?
Repeat full name and service address back to customer. Obtain ESIID.
Customer's Name
First
Middle
Last
Address
Street Address
Address Line 2
City
State
ZIP
ESI-ID
Do you confirm I have entered the correct service address and ESIID information? (Yes or No)
(Required)
YES
NO
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
For account purposes, please confirm Date of Birth?
(Required)
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Product Info
You have chosen the
[product_name]
residential electricity product.
This Plan has an Early Termination Fee of
[etf_amount]
.
This Plan has a contract length of
[term_length]
beginning on the service-start date.
Do you agree to the contract terms of this electricity product? (Yes or No)
(Required)
YES
NO
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
The electricity rate of
[average_rate]
cents per kilowatt-hour is an example based on a monthly usage of
[average_usage]
kilowatt-hours. This rate includes:
A fixed energy charge of
[energy_charge]
cents per kilowatt-hour A monthly base charge of $
[base_charge]
.
The current delivery charges from your Transmission Utility,
[tdu_charge]
.
This rate does not include standard taxes or future changes in delivery charges set by
[tdu]
.
Do you agree to the rate summary I’ve outline for you? (I AGREE or DO NOT AGREE)
(Required)
AGREE
DO NOT AGREE
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
We will submit your account for a 3- day review. Once accepted, we will arrange for your new service to begin on the requested start date of
[requested_start_date]
. Please note that it is your responsibility to make any arrangements with your current electricity provider and to pay any early termination fees associated with current active contracts, if applicable.
Do you understand this disclosure and agree to the service start date I have outlined? (Yes or No)
(Required)
YES
NO
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
Customer Authorization
Are you at least 18 years old and authorized to select or change the electricity provider for the service address of [service_address]? (Yes or No)
(Required)
YES
NO
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
Do you agree to become a (REP) customer and allow us to complete the tasks required to switch your electric service from your current REP to Ranchero Power? (Yes or No)
(Required)
YES
NO
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
If your enrollment is a switch request, You have 3 business days to rescind this agreement once you receive your terms of service, without penalty. After the period has ended, you may be subject to an early termination fee if you cancel your agreement before the end of your contracted term. Do you understand? (Yes or No)
(Required)
YES
NO
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
You will receive an account number and a written copy of the documented terms of service that explain all the terms of the agreement and how to exercise the right of rescission via mail/email within 3-business days from today. This offer is subject to withdrawal at any time prior to finalizing your account set-up and service start date with Ranchero Power. Do you agree? (Yes or No)
(Required)
YES
NO
THE CUSTOMER MUST ANSWER "YES". IF NOT, THE ENROLLMENT CAN NOT BE SENT.
Would you like to receive your customer documents in English or Spanish?
(Required)
ENGLISH
SPANISH
You will receive a welcome e-mail to the address on file with all your new account information. You will also receive login instructions for your free online portal. From your portal you can access account documents, monthly statements, pay your monthly bills, even check your daily and monthly usage. Feel free to contact us at any time if you have any questions. Our Customer Care number is 1-888-204-3202.
Comments
This field is for validation purposes and should be left unchanged.
