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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:*
- EcoChoice100 National – Variable (monthly) | $0.1099 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.1549 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
- EcoChoice100 National – Fixed (12 months) | $0.1199 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Fixed (12 months) | $0.1699 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
Renewable Electricity Rates - Residential:*
- EcoChoice100 National – Variable (monthly) | $0.1099 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.1549 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
- EcoChoice100 National – Fixed (12 months) | $0.1199 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Fixed (12 months) | $0.1699 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
For commercial accounts, click here to submit a custom quote.
Utility
Renewable Natural Gas Rates - Residential:*
- RNG – Variable (monthly) | $0.7999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking. (see terms and conditions)
Renewable Natural Gas Rates - Residential:*
- RNG – Variable (monthly) | $0.7999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking. (see terms and conditions)
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
Promo Code Confirmed. Offer open only to new renewable electricity members. Must enroll by 9/15/23 and maintain active service for a minimum of 60 days.
Offer open only to new renewable electricity members. Must enroll by 4/27/23 and maintain active service for a minimum of 60 days.

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:*
- EcoChoice100 National – Variable (monthly) | $0.1099 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.1549 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
- EcoChoice100 National – Fixed (12 months) | $0.1199 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Fixed (12 months) | $0.1699 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
Renewable Electricity Rates - Residential:*
- EcoChoice100 National – Variable (monthly) | $0.1099 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Variable (monthly) | $0.1549 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
- EcoChoice100 National – Fixed (12 months) | $0.1199 / kWh
  EcoChoice100 National provides clean electricity from wind and solar projects nationwide. (see terms and conditions)
- EcoChoice100 Pennsylvania – Fixed (12 months) | $0.1699 / kWh
  EcoChoice100 Pennsylvania provides locally generated clean electricity from wind and solar projects solely within the Commonwealth. (see terms and conditions)
Utility
Renewable Natural Gas Rates - Residential:*
- RNG – Variable (monthly) | $0.7999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking. (see terms and conditions)
Renewable Natural Gas Rates - Residential:*
- RNG – Variable (monthly) | $0.7999 / Ccf
  RNG provides 100% renewable natural gas from organic waste facilities. No drilling, no fracking. (see terms and conditions)
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. You will receive a link to the applicable renewable electricity terms and conditions in a confirmation email are they are available on our website for review. Note that The Energy Co-op does NOT have any membership or cancellation fees. If you have any questions or concerns, you can contact us anytime to discuss. Do you agree to The Energy Co-op staff submitting your enrollment for renewable electricity service with The Energy Co-op?
- Yes, I agree to The Energy Co-op staff submitting an enrollment for renewable electricity service on my behalf and understand that the terms and conditions have been provided to me via email and are available on the website for review.
Acknowledgment*
Read to Enrollee:
Your information is verified, and we are ready to submit your enrollment. You will receive a link to the applicable renewable natural gas terms and conditions in a confirmation email are they are available on our website for review. Note that The Energy Co-op does NOT have any membership or cancellation fees. If you have any questions or concerns, you can contact us anytime to discuss. Do you agree to The Energy Co-op staff submitting your enrollment for renewable natural gas service with The Energy Co-op?
- Yes, I agree to The Energy Co-op staff submitting an enrollment for renewable natural gas service on my behalf and understand that the terms and conditions have been provided to me via email and are available on the website for review.
Comments
This field is for validation purposes and should be left unchanged.

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Philadelphia, PA 19102

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