Community Choice Power Supply Program Constellation OPT-OUT or OPT-IN FORM

Community Name(required)

OPT-OUT or OPT-IN(required)

OPT-IN

OPT-OUT

Account Number(required)

PLEASE ENTER FULL UTILITY (NOT SUPPLIER) ACCOUNT NUMBER: NGRID = 10 DIGITS, EVERSOURCE = 11 DIGITS, UNITIL = 11 DIGITS.

Service Reference # (REQUIRED for Eversource WEST ONLY)

9 DIGITS, FOUND ON THE LEFT SIDE OF THE SECOND PAGE IN THE BLUE BOX.

Meter # (REQUIRED for Eversource and UNITIL ONLY)

FOUND ON THE LEFT SIDE OF THE SECOND PAGE IN THE PALE GREEN STRIP.

Account Type(required)

Residential

Commercial

Industrial

Streetlight

Name on Account(required)

PLEASE ENTER SERVICE NAME EXACTLY AS IT APPEARS AT THE TOP OF THE BILL.

Street Address(required)

PLEASE ENTER SERVICE ADDRESS (NOT NECESSARILY THE BILLING ADDRESS).

Address Line 2

City(required)

State

Zip Code(required)

Email Address(required)

Phone(required)

Type the characters(required)