StormSentry Enrollment Form

STORMSENTRY

Enrollment Form

(Before signing up, see the StormSentry Terms and Conditions.)

Yes, I want to enroll in the StormSentry program. I understand that SMECO will bill me $5.25 per month plus tax on my electric bill. All information on this form must be filled in.

Name:
E-mail Address:
Mailing Address:
Street Address
City, State, ZIP Code:

Account Number: (from electric bill)
Daytime phone:

For my complimentary plug-in surge protector, I would like the: (pick one)

Unit with two electrical receptacles and a television cable/antenna connector
Unit with two electrical receptacles and a telephone/modem connector

I understand that a fee of $50 will be billed to my account if I withdraw from the program within 12 months of enrollment.

I understand that plug-in surge protectors are needed if I want to protect my computers, televisions, VCRs, DVD players, telephones, answering machines, medical equipment, stereo equipment, and microwaves.

I have read and understood the terms and limitations above.