Powerbill

Account Information

Company Name (If Applicable):

First Name: *

Last Name: *

Phone (numbers only): *

Email (username): *

Password (min 6 characters): *

Password Confirmation: *

Address Information

Unit or Suite Number:

House Number: *

Street Name: *

Street Type: *

City Quadrant:

City: *

Province:

Postal Code (T0A0A0): *

Site Information

Requested Service(s) : *

Utility Service Date: * Please note that the Internet service will take up to a week to activate.

Optional Information

If you are signing up for Utilities: Site ID's found on your current utility bill. If you do not know your Site ID, please enter 13 zeros.

Natural Gas Site ID (13-Digits):

Electricity Site ID (13-Digits):

If you are signing up for Internet:

Is shaw cable currently active on site?

If a cable run is required by Shaw, a $200 install fee may apply. If you have any questions, please contact us at 1-855-637-2868.

Promo Code:

Representative:

PowerBill Utility Billing Solutions Inc. Disclosure Statement

Before you enter into a marketing contract for the supply of energy you should understand the following:

1. This contract is not an electricity or gas utility or government rebate program.

2. PowerBill Utility Billing Solutions Inc. may not be able to supply energy cheaper than your current utility company.

3. This contract can be ended only under the following conditions: PowerBill Utility Billing Solutions Inc. requires 10 day’s written notice (via email) to cancel the contract.

4. If you move to another location within Alberta you will not be responsible to buy energy under this contract.

5. You may cancel this contract from the day you acknowledge the contract until 10 days after a copy of the contract that you acknowledged is received by the marketer.

* You do not need a reason to cancel the contract.

* To cancel the contract, you must give notice of cancellation at the address in the contract.

* You may give notice of cancellation by any method that will allow you to prove that you gave notice, including mail, fax, e-mail or by personal delivery.

* Under certain circumstances you may have more than 10 days to cancel the contract.

* If you need more information on canceling the contract, or if you feel you have been treated unfairly, you may contact Service Alberta at 780-427-4088. Outside Edmonton call 1-877-427-4088 toll-free.

The party identified in the header of your customer sign-up form is an authorized community partner or independent broker of PowerBill Utility Billing Solutions Inc., a licensed retailer of electricity (retail license #341598) and natural gas (retail license #341597) in the Province of Alberta.

* I Accept the Terms & Conditions and the Disclosure Statement listed above

Customer Sign-Up Form

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