Apartment Manager's Referral Program Sign-Up Form

This form is for Apartment Managers or Leasing Agents to sign up for our Referral Bonus Program.

If you would like to call us directly, please dial, 1-281-819-3661

* indicates required field

Apartment Complex Infomation

Complex Name*

Address*

City, State, Zip*

Office Phone*

Office Email*

Office FAX*

Total Number of Units*

>Move-Ins Per Month:

High:*

Low:*

Do you allow DirecTV?*

Yes No

Make checks payable to:

Name*

Mailing Address*

City, State, Zip

Phone (personal)

Email (personal)

Birthday Month

Terms:

Current Utilities agrees to pay a referral bonus according to the bonus schedule (potentially up to $100 each active customer*) for each customer actively referred by you to us.

*Active means that the customer has been successfully enrolled and is a customer with a Retail Electric Provider, Cable Provider or a Satellite Provider through Current Utilities, Inc and that the customer has been active for two weeks with a Retail Electric Provider, Cable Provider or a Satellite Provider and Current Utilities, Inc.

By submitting this form you are stating that you want to do this program.

Anything else you would like to communicate to Current Utilities?