Sign-up form Homes Sign Up Oops… We found issues with your submission. Customer Information *Required Fields First name* Please enter a value Last name* Please enter a value Email* Please enter a valid email address Confirm email* Please re-confirm your email address Phone number* Please enter a valid phone number How did you hear about us?* Word of MouthOnline AdBillboardNewspaper/Magazine ArticleLawn Sign/Bullfrog Power SignTVPrint AdRadioEmailEventSocial MediaBullfrogpowered OrganizationOther Please let us know how you heard about us Your bullfrogpowered Location *Required Fields Address* Please enter a value Suite/Unit City* Please enter a value Province* AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon Please enter a value Postal code* Please enter a value Same address for billing? Billing Address Address* Please enter a value Suite/Unit Please enter a value City* Please enter a value Province* AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon Please enter a value Postal code* Please enter a value Yes, sign me up for green electricity Green Electricity ($0.025 per kWh) Option 1 My Monthly Usage kWh Please enter a value Green Electricity Cost: TBD Yes, sign me up for green natural gas green natural gas ($0.187 per m³ or $4.90 per GJ) My Monthly Usage m³ Please enter a value Green Natural Gas Cost: TBD Green Energy Premium 100% green electricity and 100% green natural gas Green electricity: TBD Green natural gas: TBD Your package: TBD Monthly discount: -$5.00 for the first 5 months Taxes: TBD Promo code You’ll see your promo code discount applied on your first statement. Referrer Please enter the name of the person who referred you here. Total: TBD You will be invoiced monthly starting one month from today’s date. This bill is in addition to your existing energy bills. Payment Details Please select payment method: Please select payment Pre-authorized credit card Card type American ExpressMastercardVisa Please enter a value Card number Please enter a value Expiry month 01 – January02 – February03 – March04 – April05 – May06 – June07 – July08 – August09 – September10 – October11 – November12 – December Expiry year 20152016201720182019202020212022202320242025 Please enter a value CVV Please enter a value Name on card Please enter a value I hereby authorize Bullfrog Power to charge my credit card. Please enter a value Pre-authorized banking Apply for pre-authorized banking. Download Form I authorize Bullfrog Power to commence my service and billing as per the information I have submitted and confirmed. I understand and agree to Bullfrog Power’s terms and conditions. Note: You will receive a customized copy of your residential agreement and a copy of Bullfrog Power’s terms and conditions once you have completed your enrolment. Please enter a value Extra Information Please send me Bullfrog’s Welcome Kit as part of my enrolment. Show my support for renewable energy on the green energy champions listing of Bullfrog customers on bullfrogpower.com Please display my name as: For example, first and last names, such as ‘John and Jane Green’ or family name like ‘The Green Family’ I would like to receive the eBuzz newsletter via email. Submit Skip back to navigation
