First Name
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Last Name
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Email
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Phone
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Address
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City
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State
*
Postal code
*
English Or Spanish?
English
Spanish
Utility Company
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Upload/take a pic of your power bill
*
Upload/take a pic of your power bill
Preferred Time
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Morning
Afternoon
Evening
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What's Your Average Electric Bill?
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$0-50
$51-100
$101-150
$151-200
$201-300
$301-400
$401-500
$501-600
$601-700
$701-800
$801+
Referring Agents
Cameron Thomas
Brandon Williams
Joseph Martinez
Daquaylan Martin
Vernon Heartfield
Torry Rodgers
Jimmie Milburn
Dawson Wynans
Jeremiah Hartfield
Jacoby Compton
Energy Team(Enter Name in Notes)
Treyvin Milburn
Kaileon Wallace
Darrell Favis
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Lead Source Drop Down
Referring Agent Name
Dallas D2D
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Notes for the energy consultant
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terms & conditions
provided by the company. By providing my phone number, I agree to receive text messages from the business.
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