Customer Enrollment Checklist

Please complete form fully.

First/Last Name

Mobile Phone

Email

Language Preference
English   Spanish

Address

Apartment/Unit

City/State/Zip

New Service Start Date

Service(s)
Electricity   Internet   Both  

Additional Info




Leasing Agent has obtained permission from consumer to disclose their nonpublic personal information to MFSMC, LLC - Electricity.Guru. This release includes their phone numbers, new address, social security number and date of birth. The sole purpose for this release is to establish utility services for this prospective client. *It is required that all requests for service be verified by an independent third party. Third Party Verification 866-942-6248.

Questions or need assistance? Call Mikenzie Grigley (407) 432-4372

*It is required that all requests for service be verified by an independent third party.