Residential Electricity Service Request Form

Fantastic choice! Pay as you go electricity by dPi Energy.

To get started with lower rates and better service, please complete the form below.

Customer & Billing Information
First Name: *
Last Name: *
Phone: *
Mobile Phone: *
Email: *
4 digit PIN #: *
Service Address: *
Apartment #:
City:
State:
Zip:

Billing Address
  *
City:
State: *
Zip: *
Service Information
Type of Dwelling?
# of Bedrooms?
*Your address and number of bedrooms will be verified by county tax records. If you select the incorrect number of bedrooms, you will be billed the difference.
 Authorization

I Agree

  Customer Initials
*You are responsible for choosing the correct address. If you need assistance with verifying the correct address, please call Sales at: 1-866-995-9777. I agree I will be held responsible for incorrect address set-up, and I agree to hold dPi Energy and its subsidiaries harmless for an incorrect address choice made by me. I understand and agree to these terms when setting up my new energy account.
*I have reviewed and understand the terms of service and conditions outlined in the contract above for my service address. (required)
I would like to receive a copy of the Terms of Service Agreement by US Mail.
I prefer to receive correspondence in Spanish.
Please send me updates and special offers by e-mail.
Check this box to attest that a person at this location uses critical life support equipment. I further understand that I will have to complete an affidavit to affirm this.
Check this box for one month free Home Phone Service when you qualify for Lifeline Assistance. If you receive any type of government benefits, such as Medicaid, Food Stamps, SSI or other, you will qualify for Lifeline Assistance. You must also live in an area that will service Lifeline to qualify for the free month. Not all areas will qualify. Your representative will contact you to verify if you qualify for phone service.
Check this box for a $100 Cash Rebate—You must fill out an application and return it to qualify for this offer.
Authorization Signature. By typing my name in the box provided below, I certify that I am at least 18 years old and legally authorized to select a retail electric provider for the service address above.
Name: Enter full name as it appears above: