HEATH COMMUNITY CHOICE POWER SUPPLY PROGRAM ENROLLMENT CHANGE FORM Please complete the form below to submit your enrollment change request. Be sure to enter all information as it appears on your electricity bill. Please note that enrollment changes may take up to two billing cycles to appear on your bill.Local Utility(Required) National Grid Enrollment Change Requested(Required) OPT-IN OPT-OUT If you have a “Supplier Block” on your account, you must call your local utility and have it removed before submitting this form. If you are a tax exempt small business consumer you must send or fax a copy of your Small Business Energy Exemption (“Form SBE”) to your Community’s supplier. (See your Community’s Program page for more details.)Account Type(Required) Residential Commercial Industrial Streetlights Large industrial customers (100 kW or 500,000 kWh/yr) seeking to opt into the program may be offered a current market-based rate rather than the program rate.Product Selection(Required)Account Number(Required)Your account number has 11 digits. It can be found on the front of your bill or the first 11 digits on the opt-out card. Enter number with no spaces, dashes, or other characters Service Reference #(Required)Your service reference number can be found on the left side of the second page of you bill under the light green bar and meter number. Enter number with no spaces, dashes, or other characters Meter NumberYour meter number can be found on second page of you bill in the light green box. Enter number with no spaces, dashes, or other characters Name on Account(Required) Customer Name KeyAlthough it is not labeled, it can be found on top left corner on second page of bill below your account number. It is typically four capital letters which are usually the first four letters of the last name or business name on the bill, but not always. Spaces, dashes and other characters ARE allowed. Service Address(Required) Street Address City MAALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWY State Zip Code Same as Service Address Click this box if mailing address is the same as Service Address Mailing Address(Required) Street Address City StateALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWY State Zip Code Email(Required)Please include an email address to receive a receipt of this request for your records. Phone(Required)Please include the phone number we should use if we need to contact you about this request.Captcha
HEATH COMMUNITY CHOICE POWER SUPPLY PROGRAM