Residential Electricity Service Request Form

Bounce Energy is a fantastic choice!

To get started with lower rates and better service, please complete the form below.
For further assistance, or to complete your order online over the phone, please call
1-877-262-7054.

Customer & Billing Information
First Name: *
Last Name: *
Day Phone Number: *
Alternate Phone Number: *
Soc sec #:
*
Email: *
Service Address: *
Apartment #:
City:
State:
Zip:

Billing Address
Address: *
Apartment #:
City:
State: *
Zip: *
Service Information
Do you want to receive information in English or Spanish?
I agree to the Terms of Service (required)  To properly complete this form, please accept the Terms and Conditions by checking the box to the left. To learn more about the Terms and Conditions of this contract, click on the link to the left.
  Download Your Rights as a Customer Click on the link to the left to read about your rights as a customer (PDF format).
Bounce Energy Loyalty Program.   At Bounce Energy, we care about our customers. We want to reward you for being a good customer with our Bounce Energy Loyalty Program. Receive gift cards, companion airline tickets, price reductions and more for paying your bill on time.
What type of service do you need?
Life Support
  By selecting Yes, I attest that a person at this location uses life support equipment I further understand that I will have to complete an affidavit to affirm this.