You may use this form to pay for yourself or for someone else. If you are paying for yourself, all the information on the form should apply to you. If you are paying for someone else, make sure all of the information on the form applies to you except the customer ID field which should be the customer ID of the person for whom you are paying. After you fill out the payment form below, then click the button and a page will be displayed allowing you to enter your credit card information on a secured web page.
Any data shown below was copied from the free electricity application form. Edit any values that need to be changed before submitting the form.
The following credit cards are accepted: MasterCard, Visa.
Name:
Phone home/work:
Email Address:
Pysciall Street/City/State/Zip/Country:
Property Status:
Mail Street/City/State/Zip/Country:
Signup Method: $9.00 processing fee
Accept Terms:
Sponsoring Recruiter ID/Name:
Your new customer ID:
If you wish to recruit people for this program, you can use your customer ID as a recruiter ID for future referrals.