*Fields with an asterisk are required

CONTACT INFORMATION

  Business/Organization

*First Name 

*Last Name 

*Mailing Address

*City, State, Zip       *County  Select A County Bucks Chester Delaware Montgomery Philadelphia

*Daytime Phone Number (xxx-xxx-xxxx) 

  Evening Phone Number (xxx-xxx-xxxx) 

*Email Address 

  Help us reduce mailing costs and paper usage!  Choose to receive your confirmation, renewal notices, and

  newsletters by email.  We do not share email addresses with others.  Select your preferred contact method Email Mail

RESIDENTIAL (R) AND RESIDENTIAL HEAT (RH) ELECTRICITY SERVICE

EcoChoice100 2010 Rate: 16.2 cents/kWh

*PECO Account # (10 digits)

  If you have multiple PECO Accounts, please submit an enrollment form for each account.

  Service Address (leave blank if same as mailing address above)

     County Select A County Bucks Chester Delaware Montgomery Philadelphia

MEMBERSHIP TYPE & DUES

Membership type & dues:

$15 - Class B: Households

Any residential household or residential consumer of energy in PA.

Please note, The Co-op is still absolutely committed to providing memberships free of charge without requiring proof of income or setting specific income limits.  If you are in a low-income household (Class B members) and wish to have your dues waived, please select your appropriate membership type from above and "Dues waiver" under payment type below. Even if requesting a dues waiver, you will be asked to renew your membership annually. 

Contributions*

Help us continue offering dues waivers to members in need! 

Give an additional:

$15

$30

$45

Other amount

*Please note, because we are a member-owned cooperative and not a 501(c)3, contributions made to The Energy Cooperative are not considered tax-deductible charitable contributions.

Payment type:

Pay online now using a credit card (MasterCard, VISA, Discover)

Note: After you hit the "Submit" button below, you will be directed to a thank you page where you must click on "Pay Online Now" to connect to Click & Pledge, our secure online vendor.

Pay by check

Make check payable to The Energy Cooperative, include Membership Renewal in the memo, and mail to: The Energy Cooperative, 1528 Walnut Street, Suite 2100, Philadelphia, PA  19102

Dues waiver

N/A - My dues are current

How did you learn about The Energy Cooperative? Please Select I'm a Current Member Friend or Relative Internet search Mailing from the Co-op Newspaper PA Interfaith Climate Change Campaign Public Utility Commission/Office of Consumer Advocate Radio discussion RecycleBank Sustainable Business Network Utility Choice Weavers Way Co-op Other (Please specify below)

Please select your primary reason for enrolling:  Please select Interest in Renewable Energy Recommended by Friend or Relative Involvement in Co-op Movement Other (please specificy below)

By including your initials below and submitting this enrollment, you are agreeing to the following:

1) I have selected The Energy Cooperative as my new energy supplier through my existing PECO Energy account.

2) I authorize The Energy Cooperative to submit information about my account to PECO Energy in order to enroll in EcoChoice100 through The Energy Cooperative.

3) I have read and agreed to the 2010 Terms and Conditions.

Initialed:   (note: if you do not include your initials, your enrollment will not be submitted)

Please review your information above, print a copy of this page for your records, and then click submit. (It may take a few minutes for the confirmation page to come up.  Please only hit this button once.)

Submit

Cancel and Return to Homepage