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Agent Form

Agent Enrollment Form

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Please complete the enrollment form with the customer on the phone.

AGENT ID

Agent ID(Required)

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ACCOUNT INFO

ESI-ID(Required)

This is a 17 or 22 digit number that identifies their meter and is found on the Electric Bill. Use the Service Location Search tool above to locate a valid ESIID.

CONTACT NAME

Billing Name(Required)

First Middle Last

Relationship To Account Holder(Required)

Authorized Name(Required)

First Last

Date of Birth (Account Holder)(Required)

CONTACT INFO

Primary Phone Number(Required)

Phone Type(Required)

Alternative Phone Number

Phone Type (Alternative)

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)

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 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 State ZIP Code

Method Of Billing(Required)

Paper Billing Only

Electronic Billing Only

Both Paper and Electronic Billing

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FORM DISPOSITION

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Disposition

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Submit

Phone

This field is for validation purposes and should be left unchanged.

Ranchero Power

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Head Office
5858 Westheimer Road, Suite 707
Houston, TX 77057, USA
Phone: 1.888.204.3202
RancheroPower.com
Email: [email protected]

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