Residential
Name: ____________________________________________
Address: _________________________________________
City: _________________State:__________Zip:_______
Phone: ____________________________________________
E-mail: __________________________________________
Promotion Code:SMEL
Public Utility/Energy Provider_________________________
Public Utility Account Number___________ - ___________
Energy Provided (please Check one:
Gas and Electric___
Gas___
Electric___
I authorize Hudson Energy Services LLC to enroll the above listed account (s) with my utility so that Hudson Energy services, LLC becomes my energy supplier. This agreement is subject to Hudson Energy Services LLC’s terms and conditions.
Signature________________________ Date__________________