Utility
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Zip Code
State
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New York
)
Ohio
)
Site Details
What services would you like us to supply?
Electricity
Gas
Utility (Electricity)
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Utility (Gas)
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Products
Electricity & REC Products
Gas Products
Product Confirmation & Loyalty Plan
Electricity Product Details
Gas Product Details
I confirm my selected Electricity Product
I confirm my selected Gas Product
Promo Code
a. Additional Product Information
Choose your Package:
b. Communication Opt-Ins
Have you been referred to Kiwi Energy by a friend or Ecogold Partner Program?
* Required *
No
)
Friend
)
Ecogold Partner
)
Customer Name
Customer Number
Partner Code
c. Future Communication
Receive Emails
I agree to allow Kiwi Energy / Spring Power & Gas to send communication via email.
Receive SMS
I agree to allow Kiwi Energy / Spring Power & Gas to send communication via SMS.
Customer Information
Contact Information
First Name*
Last Name
Address
Address Line 2
City
ZIP Code
Phone Number
Email
Utility Account Information
(Electricity)
(Gas)
Review Details
Review Your Details
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Declaration
By submitting this form, I confirm that:
I confirm my enrollment for service and have read, understand, accept and agree to the
Electricity Terms and Conditions
and the
Electricity Customer Disclosure Statement
.
I confirm my enrollment for service and have read, understand, accept and agree to the
Gas Terms and Conditions
and the
Gas Customer Disclosure Statement
.
I am the account holder or a person that has legal authorization on this account and am over the age of 18 and have viewed the
ESCO Consumer Bill of Rights
. I authorize Kiwi Energy to obtain and review information regarding my consumption history from the Utility.
I understand that this electronic acceptance is an agreement to initiate service and begin enrollment and authorization to receive my agreement electronically via email. This information may be used by Kiwi Energy to determine whether it will commence and/or continue to provide energy supply service to me and shall not be disclosed to third party unless needed as specified in the contract.
You may rescind this sales agreement and authorization within 3 calendar days after electronic acceptance of the sales agreement, and may rescind the authorization for release of information at anytime. I understand that energy supply will be provided by Kiwi Energy and energy delivery will continue to be provided by my utility. Your utility will be available to respond to leaks or other emergencies should they occur.
If you would prefer a printed version of the agreement, Kiwi Energy will send a hard copy by mail within 3 business days after the request is placed. You may request a hard copy of your sales agreement or request to rescind by calling into our toll-free telephone number at 1-877-208-7636 or email us at info@kiwienergy.us. To print a copy of the Terms and Conditions, Customer Disclosure Statement or the Consumer Bill of Rights follow the links above.
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