Customer Sign-Up Form
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Address
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Promo code and agreements
Account Information
Company Name (if applicable):
First Name:
*
Last Name:
*
Phone (numbers only):
*
Email (username):
*
Password (min 6 characters):
*
Password Confirmation:
*
Address Information
Look Up Address:
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Unit or Suite Number:
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Unit or Suite Number:
House Number:
*
Street Name:
*
Street Type:
*
City Quadrant:
Not Applicable
NW
NE
SW
SE
City:
*
Province:
AB
Postal Code:
*
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Select Desired Service(s)
Select services that you are interested in:
*
Electricity
Gas
Utility Information
Utility Service Start Date:
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Site ID Electricity:
This site ID cannot be registered with PowerBill at this time. Please contact
info@powerbill.ca
for more information.
Site ID Format is 13 digits. It can be found on your current utility bill.
Site ID Gas:
This site ID cannot be registered with PowerBill at this time. Please contact
info@powerbill.ca
for more information.
Site ID Format is 13 digits. It can be found on your current utility bill.
Internet Information
Estimated Internet Service Start Date:
*
Please note that the Internet service could take up to a week to activate. A service representative will contact you with more details.
Is Shaw Cable services available at your service location?
Yes
No
Unsure
If a cable run is required by Shaw, a $200 installation fee may apply. If you have any questions, please contact us at 1-855-637-2868.
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 days' 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. If you are 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.
Referred By:
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