Registration Form

Customer Information

Business Name *

First Name as appears on bill *

Last Name as appears on bill *

Business Title *

Phone Number *

Extension

Email Address *

Confirm Email Address *

How did you hear about us? *

Other

Billing Address

Street Number *

Street Name *

City *

State *

ZIP Code*

Business Name

Check if Service Address is the same as Billing Address

Service Address

Street Number *

Street Name *

City *

State *

ZIP Code*

Business Name

Utility Information

Utility Provider

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Enter Customer Number If you don't have your Customer Number, you can provide it at a later time.

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Customer’s Consent – 30-11-2022 06:37 AM

I have read and agree to RiteRate Energy Terms and Condition and Contract Summary (presented above). Completion of this agreement confirms my intent to become a customer of Riterate Energy. I appoint RiteRate Energy as my agent and authorize RiteRate energy to obtain usage information from my utility company.

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