Residential Sign Up Form
Important: Please search your zip code to find out if service is available in your area
Name......................
Email.......................
Address..................
City, State, Zip........
Billing Address.........
Day Phone...............
Evening Phone..........
Package Choice...
Electrical Repair ($5.95)
Please Choose a Billing Option:
SCE Account
(Electrical repair only.)
SCE Account #.......
Credit Card
Credit Card #..........
Name on card..........
Card Expiration........