PowerBill Utility Billing Solutions Inc.

Customer Sign-Up Form

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Account Information

Company Name: ( If applicable )

First Name: *

Last Name: *

Phone: *( Numbers only )

Email:* ( Username )

Password (min 6 characters): *

Password Confirmation: *

Date of birth ( Required for possible credit check )

Year: *

Month: *

Day: *

Address Information

Look Up Address: *

Unit or Suite Number:

Postal Code: *

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Unit or Suite Number:

House Number: *

Street Name: *

Street Type: *

City Quadrant:

City: *

Province:

Postal Code: *

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*Rural area information:

In general, a rural area is a geographic area that is located outside towns and cities.

Lot ID:

Site Number:

Compartment:

Rural Route Identifier:

Rural Route: *

Pre-Road Number:

Road Type:

City: *

Province:

Postal Code: *

*Post Office (PO) Box information:

PO Box™ service is a premium service offered for a fee to anyone who requires more than free home delivery or general delivery.
Note: A PO Box may be available for those who are not eligible for home delivery.

PO Box Number: *

City or Municipality: *

Province:

Postal Code: *

*General Delivery is a mail service for those without a permanent address, often used as a temporary mailing address. General Delivery is intended to be used for:

Post Office™ locations without city carrier delivery service.
Non-city delivery offices for those who prefer not to use Post Office Box service and for whom use of Post Office box, Caller Service, or delivery by letter carrier, would be an unreasonable inconvenience.
A participating Post Office to serve transients (people who travel extensively) and those without a permanent address.
Anyone who wants Post Office box service when Post Office boxes are unavailable.

Station Type:

Station Name:

City or Municipality: *

Province:

Postal Code: *

Select Desired Service(s)

Select services that you are interested in:*

Electricity

Gas

Internet

Utility Information

Utility Service Start Date: *

Site ID Electricity: Site ID Format is 13 digits. It can be found on your current utility bill.

Site ID Gas: 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?

If a cable run is required by Shaw, a $200 installation fee may apply. If you have any questions, please contact us at .

* I agree to PowerBill's terms and condition for internet found here

* An activation fee of $99 will be applied upon internet sign-up and will be refunded as credit after a year.

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.

* I Accept to be credit checked (Soft check and viewing your score).

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