Customer Authorization - Bold Coast Energy

For a free, no obligation analysis of your energy usage and a price proposal, please complete the form below. Alternatively you can download and print our Customer Authorization PDF and fax it to us at (855) 558-8480.

* Indicates a required field.

Customer Name*
State*
Utility*
select all that apply
Utility*
select all that apply
Utility Bill*
Upload one utility bill for each account.
Drop files here or

Accepted file types: pdf, jpg, jpeg, Max. file size: 64 MB.
Company Information
Company Name*
Email*
Phone Number*
Corporate Address*
Street Address City State
E-Signature*

By signing I authorize the above Distribution Company to share the Company’s monthly and or interval electricity data usage with Bold Coast Energy, LLC (“Broker”) until I or Broker notifies the Distribution Company otherwise. As part of this authorization, Broker has agreed to pay any applicable fees associated with this data request. Accept this form as authentic whether it is the original executed document or a copy thereof. My signature affirms that I have the authority to make and sign this request on behalf of the Company.

Company Information