Internal Enrollment Form

1Admin Info

2Service & Contact Info

3Verification

Staff Member Name*
How did they hear about us?*
If the enrollee heard about us through a partner organization, they might have a promo code depending on if we're running a promotion with the partner.
Name of Referrer
Other Details
Social media

Select Product*
Utility
Renewable Electricity Rates - Residential:*
Learn more about our terms and conditions
- EcoChoice100 National – Variable (monthly) | $0.1699 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide.
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.2299 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth.
Renewable Electricity Rates - Residential:*
Learn more about our terms and conditions
- EcoChoice100 National – Variable (monthly) | $0.1699 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide.
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.2299 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth.
For commercial accounts, click here to submit a custom quote.
Utility
Renewable Natural Gas Rates - Residential:*
Learn more about our terms and conditions
- RNG – Variable (monthly) | $2.4999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking.
Renewable Natural Gas Rates - Residential:*
Learn more about our terms and conditions
- RNG – Variable (monthly) | $2.4999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking.
For commercial accounts, click here to submit a custom quote.
Name*
First Last
Service Address*
Street Address City State ZIP Code
Billing Address
- Same as service address
Billing Address*
Street Address City State ZIP Code
Email*
Phone*
PECO Account Number*
Must be 10 digits. If your account number is less, add zeros before the number to make 10 digits.
If the enrollee needs help finding their PECO Account Number, use the image below to guide them or click here to enlarge.
PPL Account Number*
Must be 10 digits. If your account number is less, add zeros before the number to make 10 digits.
If the enrollee needs help finding their PPL Account Number, use the image below to guide them or click here to enlarge.
PECO Account Number*
Must be 10 digits. If your account number is less, add zeros before the number to make 10 digits.
If the enrollee needs help finding their PECO Account Number, use the image below to guide them or click here to enlarge.
PGW Account Number*
Must be 10 digits. Add zeros in front of your account number if it is fewer than 10 digits.
Ask if the enrollee needs help finding their PGW Account Number, PGW Service Point ID, and PGW Rate Schedule. If so, explain that it is located on page 4 of their PGW bill, and use the image below to guide the.

Or Click Here To Enlarge
PGW Service Point ID*
Must be 10 digits. If your service point ID number is less, add zeros before the number to make 10 digits.
PGW Rate Schedule
Please select your PGW rate schedule from the drop-down menu.
Date to Activate Service
MM slash DD slash YYYY
Electricity Promo Code
Renewable Natural Gas Promo Code
Invalid Promo Code
Promo Code Confirmed

Selected Product*
Verify the information you have entered with the enrollee to ensure that you captured their enrollment details correctly.
Utility
Renewable Electricity Rates - Residential:*
Learn more about our terms and conditions
- EcoChoice100 National – Variable (monthly) | $0.1699 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide.
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.2299 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth.
Renewable Electricity Rates - Residential:*
Learn more about our terms and conditions
- EcoChoice100 National – Variable (monthly) | $0.1699 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide.
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.2299 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth.
Utility
Renewable Natural Gas Rates - Residential:*
Learn more about our terms and conditions
- RNG – Variable (monthly) | $2.4999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking.
Renewable Natural Gas Rates - Residential:*
Learn more about our terms and conditions
- RNG – Variable (monthly) | $2.4999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking.
Name*
First Last
Service Address*
Street Address City State ZIP Code
Billing Address
- Same as service address
Billing Address*
Street Address City State ZIP Code
Email*
Phone*
PECO Account Number*
PPL Account Number*
PECO Account Number*
PGW Account Number*
PGW Service Point ID*
PGW Rate Schedule
Date to Activate Service
MM slash DD slash YYYY
Electricity Promo Code
Renewable Natural Gas Promo Code
Acknowledgment*
Read to Enrollee:
Your information is verified, and we are ready to submit your enrollment. The Energy Co-op's Renewable Electricity terms and conditions are available on our website for review. You will receive a link to those terms and conditions in the enrollment receipt email which you should receive within one (1) business day of the enrollment being submitted. Note that The Energy Co-op does NOT have any membership or cancellation fees. If you have any questions or concerns after reviewing the terms and conditions, you can contact us anytime to discuss. Do you agree to submitting your enrollment for Renewable Electricity service with The Energy Co-op?
- Yes, enrollee agrees to submitting their enrollment for Renewable Electricity service.
Acknowledgment*
Read to Enrollee:
Your information is verified, and we are ready to submit your enrollment. The Energy Co-op's Renewable Natural Gas terms and conditions are available on our website for review. You will receive a link to those terms and conditions in the enrollment receipt email which you should receive within one (1) business day of the enrollment being submitted. Note that The Energy Co-op does NOT have any membership or cancellation fees. If you have any questions or concerns after reviewing the terms and conditions, you can contact us anytime to discuss. Do you agree to submitting your enrollment for Renewable Natural Gas service with The Energy Co-op?
- Yes, enrollee agrees to submitting their enrollment for Renewable Natural Gas service.
Comments
This field is for validation purposes and should be left unchanged.

Have questions? Give us a call at 215.413.2122.